Organization
LES J. KICKLIGHTER, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LES J. KICKLIGHTER D.M.D. (PRESIDENT)
(912) 489-4151
Entity
Organization
Contact information
Practice address
512 GENTILLY RD, STATESBORO, GA 30458-5149
(912) 489-4151
Mailing address
512 GENTILLY RD, STATESBORO, GA 30458-5149
(912) 489-4151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012401
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00956007A
—
GA
Enumeration date
03/07/2007
Last updated
08/22/2020
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