Organization
GOLDEN ISLES ORAL SURGERY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER E. HALL D.M.D. (OWNER)
(912) 264-6420
Entity
Organization
Contact information
Practice address
17 PROFESSIONAL DRIVE, SUITE 100, BRUNSWICK, GA 31520-3794
(912) 264-6420
(912) 264-6242
Mailing address
17 PROFESSIONAL DRIVE, SUITE 100, BRUNSWICK, GA 31520-3794
(912) 264-6420
(912) 264-6242
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN011864
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
667957245C
—
GA
Enumeration date
09/11/2012
Last updated
10/15/2012
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