Individual
BRENT DEPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2711 WINDEMERE DR, VALDOSTA, GA 31602-1696
(229) 247-0437
(229) 242-4395
Mailing address
2711 WINDEMERE DR, VALDOSTA, GA 31602-1696
(229) 247-0437
(229) 242-4395
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
012319
GA
Other
Enumeration date
09/23/2006
Last updated
04/09/2020
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