Organization
DENTAL CENTER OF VIDALIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE J. WALLER (FINANCIAL COORDINATOR)
(912) 537-7048
Entity
Organization
Contact information
Practice address
1209 EAST FIRST STREET, VIDALIA, GA 30474
(912) 537-7048
Mailing address
P.O. BOX 524, VIDALIA, GA 30475
(912) 537-7048
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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