Individual
DR. NICHOLAS THEODOTOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BDS, DDS
Contact information
Practice address
506 US HIGHWAY 80 W, POOLER, GA 31322-2104
(912) 600-6060
Mailing address
506 US HIGHWAY 80 W, POOLER, GA 31322-2104
(912) 600-6060
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN011530
GA
Other
Enumeration date
03/23/2009
Last updated
08/09/2021
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