Organization
LAKESIDE ORAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER TOMLINSON (CREDENTIALING SPECIALIST)
(404) 410-1340
Entity
Organization
Contact information
Practice address
1097 LAKE OCONEE PKWY STE 101, EATONTON, GA 31024-9510
(706) 916-4764
Mailing address
1097 LAKE OCONEE PKWY STE 101, EATONTON, GA 31024-9510
(706) 916-4764
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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