Organization
BRAY, DMD & YOUNG, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CECIL B BRAY III DMD (PRESIDENT)
(912) 489-1386
Entity
Organization
Contact information
Practice address
2 LESTER CT, STATESBORO, GA 30458-2118
(912) 489-1386
(912) 764-8533
Mailing address
715 NORTHSIDE DR E, SUITE 5, PMB 395, STATESBORO, GA 30458-4712
(912) 489-1386
(912) 764-8533
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9793
GA
1223P0221X
Pediatric Dentistry
10099
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00328314B
—
GA
05
—
00328622B
—
GA
Enumeration date
08/21/2006
Last updated
11/06/2007
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