Organization
CORNELIA DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH LEON JACKSON DDS (OWNER)
(706) 778-8645
Entity
Organization
Contact information
Practice address
105 HIGHLAND AVE, CORNELIA, GA 30531-4366
(706) 778-8645
(706) 776-2650
Mailing address
105 HIGHLAND AVE, CORNELIA, GA 30531-4366
(706) 778-8645
(706) 776-2650
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN009940
GA
Other
Enumeration date
03/25/2014
Last updated
03/25/2014
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