| Van Tuyl Dental Group | |
|
929 Cove Rd Suite F Jasper GA 30143-4444 | |
| (706) 692-3759 | |
| Not Available |
| Full Name | Van Tuyl Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 929 Cove Rd, Jasper, Georgia |
| Authorized Official Name and Position | Jamie L Dickerson (OFFICE MANAGER) |
| Authorized Official Contact | 7703456600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Van Tuyl Dental Group 929 Cove Rd Suite F Jasper GA 30143-4444 Ph: (706) 692-3759 | Van Tuyl Dental Group 929 Cove Rd Suite F Jasper GA 30143-4444 Ph: (706) 692-3759 |
| NPI Number | 1811121445 |
|---|---|
| Provider Enumeration Date | 05/11/2009 |
| Last Update Date | 05/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811121445 | NPI | - | NPPES |
| 841686753 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN013002 (Georgia) | Primary |
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