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Organization

VIDALIA ORAL AND MAXILLOFACIAL SURGERY, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RONALD O MOSLEY D.M.D. (PRESIDENT)
(912) 537-4119
Entity
Organization

Contact information

Practice address
310 MAPLE DR, VIDALIA, GA 30474-8909
(912) 537-4119
(912) 537-9117
Mailing address
310 MAPLE DR, VIDALIA, GA 30474-8909
(912) 537-4119
(912) 537-9117

Taxonomy

Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
01415
GA

Other

Enumeration date
03/11/2008
Last updated
03/11/2008
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