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Organization
PALMETTO FAMILY DENTAL OF PIKE COUNTY
Active
Organization
PALMETTO FAMILY DENTAL OF PIKE COUNTY
Active
Other names
Palmetto Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN ALBERT BRUNSON DDS (PRESIDENT)
(770) 567-8000
Entity
Organization
Contact information
Practice address
15988 BARNESVILLE ST., ZEBULON, GA 30295
(770) 567-8000
(770) 567-8600
Mailing address
15988 BARNESVILLE ST., ZEBULON, GA 30295
(770) 567-8000
(770) 567-8600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN013693
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
685019718C
—
GA
Enumeration date
08/13/2013
Last updated
07/20/2022
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