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Organization
SOUTHWEST ORAL AND MAXILLOFACIAL SURGERY,LLC
Active
Organization
SOUTHWEST ORAL AND MAXILLOFACIAL SURGERY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD J HARRIS D.M.D. (SOLE MEMBER/ORAL SURGEON)
(678) 350-6566
Entity
Organization
Contact information
Practice address
620 POINTE NORTH BOULEVARD, ALBANY, GA 31721
(678) 350-6566
Mailing address
PO BOX 4896, CANTON, GA 30114-0026
(678) 350-6566
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DNO12915
GA
Other
Enumeration date
12/24/2009
Last updated
12/24/2009
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