Organization
AZALEA CITY FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM W BROADFOOT JR. D.D.S. (CEO)
(229) 244-3700
Entity
Organization
Contact information
Practice address
414 PENDLETON PL, VALDOSTA, GA 31602-2603
(229) 244-3700
(229) 247-0373
Mailing address
414 PENDLETON PL, VALDOSTA, GA 31602-2603
(229) 244-3700
(229) 247-0373
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN007995
GA
Other
Enumeration date
04/09/2009
Last updated
04/09/2009
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