Organization
LAGRANGE FAMILY DENTAL CENTER
Active
Other names
George W Baker Jr
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE W BAKER JR. D.M.D (OWNER)
(706) 882-5551
Entity
Organization
Contact information
Practice address
606 S GREENWOOD ST, LAGRANGE, GA 30240-3128
(706) 882-5551
(706) 812-8558
Mailing address
PO BOX 2030, LAGRANGE, GA 30241-0042
(706) 882-5551
(706) 812-8558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8745
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386680734
—
GA
05
—
1669413993
—
GA
Enumeration date
11/03/2008
Last updated
12/28/2011
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