Organization
DONALD A. BETHEA, D.D.S., L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD ALAN BETHEA D.D.S. (DENITST/OWNER)
(912) 285-1218
Entity
Organization
Contact information
Practice address
410 LISTER ST, WAYCROSS, GA 31501-5226
(912) 285-1218
Mailing address
410 LISTER ST, WAYCROSS, GA 31501-5226
(912) 285-1218
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN011225
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003143408A
—
GA
05
—
5440634
—
TN
Enumeration date
06/18/2014
Last updated
06/18/2014
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