Organization
LAKESIDE FAMILY DENTISTRY AND TMJ, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP SHELBY TULLY III DMD (PRESIDENT)
(706) 323-6491
Entity
Organization
Contact information
Practice address
7270 N LAKE DR STE 100, COLUMBUS, GA 31909-2764
(706) 323-6491
(706) 323-2671
Mailing address
7270 N LAKE DR STE 100, COLUMBUS, GA 31909-2764
(706) 323-6491
(706) 323-2671
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/17/2006
Last updated
09/11/2024
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