Organization
PROVIDENCE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JASON MANN DMD (OWNER)
(478) 733-0857
Entity
Organization
Contact information
Practice address
225 N MACON ST, MACON, GA 31210-6562
(478) 733-0857
(478) 254-5709
Mailing address
225 N MACON ST, MACON, GA 31210-6562
(478) 733-0857
(478) 254-5709
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013536
GA
Other
Enumeration date
04/22/2016
Last updated
07/11/2024
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