Organization
TOWNE LAKE DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN BEAUDREAU D.M.D. (OWNER/DENTIST)
(912) 330-4545
Entity
Organization
Contact information
Practice address
125 SOUTHERN JUNCTION BLVD, SUITE 701, POOLER, GA 31322-2214
(912) 330-4545
Mailing address
125 SOUTHERN JUNCTION BLVD, SUITE 701, POOLER, GA 31322-2214
(912) 330-4545
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
09617
GA
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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