Organization
DYESS PARKWAY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED M HANNAN SR. D.D.S. (DENTIST)
(706) 868-4200
Entity
Organization
Contact information
Practice address
4045 JIMMIE DYESS PKWY STE 103, AUGUSTA, GA 30909-9492
(706) 868-4200
(706) 868-4717
Mailing address
4045 JIMMIE DYESS PKWY STE 103, AUGUSTA, GA 30909-9492
(706) 868-4200
(706) 868-4717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6539
GA
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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