| Quitman Family Dentistry Llc | |
|
1306 E. Screven Street Quitman GA 31634 | |
| (229) 263-8700 | |
| Not Available |
| Full Name | Quitman Family Dentistry Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1306 E. Screven Street, Quitman, Georgia |
| Authorized Official Name and Position | Larry M Black (OWNER) |
| Authorized Official Contact | 2292638700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Quitman Family Dentistry Llc 1306 E. Screven Street Quitman GA 31634 Ph: (229) 263-8700 | Quitman Family Dentistry Llc 1306 E. Screven Street Quitman GA 31634 Ph: (229) 263-8700 |
| NPI Number | 1639426836 |
|---|---|
| Provider Enumeration Date | 08/07/2012 |
| Last Update Date | 08/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639426836 | NPI | - | NPPES |
| 003124373A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN012932 (Georgia) | Primary |
| 261QD0000X | Clinic/center - Dental | DNSC000233 (Georgia) | Secondary |