Individual
BENJAMIN M PRIDEMORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
23 JOHN MADDOX DR NW, ROME, GA 30165-1413
(706) 234-0877
(706) 232-5327
Mailing address
23 JOHN MADDOX DR NW, ROME, GA 30165-1413
(706) 234-0877
(706) 232-5327
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN007095
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN007095
STATE LICENSE NUMBER
GA
Enumeration date
07/27/2006
Last updated
07/08/2007
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