Organization
MARK A. RETTERBUSH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ALLEN RETTERBUSH D.M.D. (DR/ OWNER)
(229) 244-1633
Entity
Organization
Contact information
Practice address
2311 N PATTERSON ST, VALDOSTA, GA 31602-2510
(229) 244-1633
(229) 244-4663
Mailing address
2311 N PATTERSON ST, VALDOSTA, GA 31602-2510
(229) 244-1633
(229) 244-4663
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9831
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000272159A
—
GA
01
—
1356486575
NPI INDIVIDUAL
GA
01
—
9181766
DORAL
GA
Enumeration date
06/11/2009
Last updated
06/11/2009
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