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Organization
MIDDLE GEORGIA ORAL AND MAXILLOFACIAL SURGERY LLC
Active
Organization
MIDDLE GEORGIA ORAL AND MAXILLOFACIAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENDON WILLIAM SMALLEY III DMD (ORAL SURGEON)
(706) 340-3408
Entity
Organization
Contact information
Practice address
117 S CALHOUN ST, DUBLIN, GA 31021-5245
(706) 340-3408
Mailing address
401 CREST DR, BIRMINGHAM, AL 35209-5525
(478) 290-7275
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN014148
STATE LICENSE
GA
Enumeration date
07/01/2019
Last updated
07/01/2019
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