Organization
PORT CITY FAMILY DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZI RUSH-KRAFT (OFFICE MANAGER)
(229) 246-5081
Entity
Organization
Contact information
Practice address
709 E SHOTWELL ST, BAINBRIDGE, GA 39819-4063
(229) 246-5081
(229) 246-5011
Mailing address
POST OFFICE BOX 1307, BAINBRIDGE, GA 39818
(229) 246-5081
(229) 246-5011
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9222
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00205927A
—
GA
05
—
335406129B
—
GA
Enumeration date
07/29/2008
Last updated
07/29/2008
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