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Organization
MACON PERIODONTICS AND IMPLANT DENTISTRY, LLC
Active
Organization
MACON PERIODONTICS AND IMPLANT DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAY WILLIS (BUSINESS COORDINATOR)
(478) 742-4254
Entity
Organization
Contact information
Practice address
1923 HARDEMAN AVE, MACON, GA 31201-1162
(478) 742-4254
(478) 742-1457
Mailing address
1923 HARDEMAN AVE, MACON, GA 31201-1162
(478) 742-4254
(478) 742-1457
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/23/2012
Last updated
07/23/2012
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