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Organization
STATESBORO CHILDREN'S DENTAL CENTER, PC
Active
Organization
STATESBORO CHILDREN'S DENTAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN L WASDIN D.M.D. (OWNER)
(912) 871-6197
Entity
Organization
Contact information
Practice address
1501 BRAMPTON AVE, STATESBORO, GA 30458-0856
(912) 871-6197
(912) 871-6203
Mailing address
1501 BRAMPTON AVE, STATESBORO, GA 30458-0856
(912) 871-6197
(912) 871-6203
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN011889
GA
Other
Enumeration date
12/10/2007
Last updated
12/10/2007
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