Organization
EISENHOWER PARKWAY DENTAL GROUP, LLC
Active
Other names
Youth Dentistry of Macon
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA SUSAN ZOELLER (AUTHORIZED OFFICIAL)
(615) 988-2627
Entity
Organization
Contact information
Practice address
1536 EISENHOWER PKWY, MACON, GA 31206
(478) 781-4333
(478) 781-4331
Mailing address
401 CHURCH ST STE 2210, NASHVILLE, TN 37219-2204
(615) 988-2627
(631) 857-7860
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015152
GA
Other
Enumeration date
10/12/2016
Last updated
07/05/2018
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