Organization
THOMASVILLE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARLIN S JOHNSON D.M.D (DENTIST/OWNER)
(229) 226-2386
Entity
Organization
Contact information
Practice address
215 CONSTITUTION AVE, THOMASVILLE, GA 31757-4843
(229) 226-2386
(229) 226-9838
Mailing address
215 CONSTITUTION AVE, THOMASVILLE, GA 31757-4843
(229) 226-2386
(229) 226-9838
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013177
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197090698C
—
GA
Enumeration date
10/21/2008
Last updated
10/21/2008
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