| Timothy B Fagan Dmd Pc | |
|
7 Longleaf Office Park Moultrie GA 31768 | |
| (229) 985-4674 | |
| (229) 985-0900 |
| Full Name | Timothy B Fagan Dmd Pc |
|---|---|
| Speciality | Dentist |
| Location | 7 Longleaf Office Park, Moultrie, Georgia |
| Authorized Official Name and Position | Timothy B Fagan (PRESIDENT) |
| Authorized Official Contact | 2299854674 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy B Fagan Dmd Pc Po Box 160 Moultrie GA 31776 Ph: (229) 985-4674 | Timothy B Fagan Dmd Pc 7 Longleaf Office Park Moultrie GA 31768 Ph: (229) 985-4674 |
| NPI Number | 1982717369 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982717369 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN011154 (Georgia) | Primary |
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Moultrie Orthodontics, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12 Longleaf Office Park, Moultrie, GA 31768 Phone: 229-985-4715 Fax: 229-985-0997 | |
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