Organization
CENTER FOR PEDIATRIC DENTISTRY, LLC
Active
Other names
Center For Pediatric Dentistry, PC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY SHIRLEY (ADMINISTRATOR)
(706) 855-8989
Entity
Organization
Contact information
Practice address
1243 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 855-8989
(706) 855-0321
Mailing address
1243 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 855-8989
(706) 855-0321
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
11680
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
945328611A
—
GA
Enumeration date
03/09/2006
Last updated
01/18/2021
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