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Organization
PINE MOUNTAIN FAMILY DENTISTRY, LLC
Active
Organization
PINE MOUNTAIN FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIDNEY DAUSTER HARDEN III D.M.D. (DENTIST)
(706) 663-2272
Entity
Organization
Contact information
Practice address
8944 HAMILTON ROAD, PINE MOUNTAIN, GA 31822
(706) 663-2272
(706) 663-2075
Mailing address
P.O. BOX 1176, PINE MOUNTAIN, GA 31822-4707
(706) 663-2272
(706) 663-2075
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DNO08005
GA
122300000X
Dentist
Primary
DNO12733
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000045295A
—
GA
05
—
594312970B
—
GA
Enumeration date
01/25/2010
Last updated
01/25/2010
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