Organization
SOUTH GEORGIA PERIODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT B. DEPTA DMD (OWNER)
(229) 247-0437
Entity
Organization
Contact information
Practice address
307 GEORGETOWN CIR, VALDOSTA, GA 31602-4113
(229) 247-0437
(229) 242-4395
Mailing address
307 GEORGETOWN CIR, VALDOSTA, GA 31602-4113
(229) 247-0437
(229) 242-4395
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/31/2008
Last updated
07/31/2008
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