Individual
DR. LES J. KICKLIGHTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
512 GENTILLY RD, STATESBORO, GA 30458-5149
(912) 489-4151
Mailing address
100 NOTTINGHAM TRL, STATESBORO, GA 30458-4265
(912) 489-2565
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
012401
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00956007A
—
GA
Enumeration date
03/26/2007
Last updated
07/08/2007
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