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Organization
BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER
Active
Organization
BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER LEE MYERS DMD (OWNER)
(912) 764-7500
Entity
Organization
Contact information
Practice address
301 FLORENCE AVE, STATESBORO, GA 30458-5138
(912) 764-7500
(912) 764-7503
Mailing address
301 FLORENCE AVE, STATESBORO, GA 30458-5138
(912) 764-7500
(912) 764-7503
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN013413
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379753056C
—
GA
Enumeration date
05/12/2010
Last updated
05/12/2010
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