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Organization
EAST GEORGIA ORAL & MAXILLOFACIAL SURGERY CENTER
Active
Organization
EAST GEORGIA ORAL & MAXILLOFACIAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODRIGO LORENZO URIBE D.M.D. (OWNER)
(912) 764-5435
Entity
Organization
Contact information
Practice address
613 E GRADY ST, STATESBORO, GA 30458-5104
(912) 764-5435
(912) 764-9789
Mailing address
613 E GRADY ST, STATESBORO, GA 30458-5104
(912) 764-5435
(912) 764-9789
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
012756
GA
261QD0000X
Dental Clinic/Center
Primary
11060
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000514489A
—
GA
05
—
478841397B
—
GA
Enumeration date
02/15/2010
Last updated
02/15/2010
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