Organization
BULLOCH ORAL AND MAXILLOFACIAL SURGERY AND DENTAL IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER LEE MYERS DMD (OWNER)
(912) 764-7500
Entity
Organization
Contact information
Practice address
301 FLORENCE AVE, STATESBORO, GA 30458-5138
(912) 764-7500
(912) 764-7503
Mailing address
301 FLORENCE AVE, STATESBORO, GA 30458-5138
(912) 764-7500
(912) 764-7503
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN013413
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379753056C
—
GA
Enumeration date
05/12/2010
Last updated
05/12/2010
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