Organization
FORD AVENUE FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAY LINTON WALLACE III DMD (DENTIST)
(912) 695-2801
Entity
Organization
Contact information
Practice address
10230 FORD AVE, RICHMOND HILL, GA 31324-8854
(912) 756-2936
Mailing address
10230 FORD AVE, RICHMOND HILL, GA 31324-8854
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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