Organization
MOULTRIE ORTHODONTICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALLAS H MARGESON D.M.D., M.S. (PRESIDENT)
(229) 985-4715
Entity
Organization
Contact information
Practice address
12 LONGLEAF OFFICE PARK, MOULTRIE, GA 31768
(229) 985-4715
(229) 985-0997
Mailing address
12 LONGLEAF OFFICE PARK, MOULTRIE, GA 31768
(229) 985-4715
(229) 985-0997
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
GA11010
GA
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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