| South Georgia Pediatric Denitstry | |
|
3227 N Oak Street Ext Suite A Valdosta GA 31605-7416 | |
| (229) 247-3200 | |
| Not Available |
| Full Name | South Georgia Pediatric Denitstry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3227 N Oak Street Ext, Valdosta, Georgia |
| Authorized Official Name and Position | Joseph C Powell (OWNER/DENTIST) |
| Authorized Official Contact | 2292473200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Georgia Pediatric Denitstry 3227 N Oak Street Ext Suite A Valdosta GA 31605-7416 Ph: (229) 247-3200 | South Georgia Pediatric Denitstry 3227 N Oak Street Ext Suite A Valdosta GA 31605-7416 Ph: (229) 247-3200 |
| NPI Number | 1104128263 |
|---|---|
| Provider Enumeration Date | 11/23/2010 |
| Last Update Date | 02/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104128263 | NPI | - | NPPES |
| 102640352A | Medicaid | GA | |
| 00917067B | Medicaid | GA | |
| 003162889B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN014976 (Georgia) | Primary |
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