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Organization

ORAL MAXILLOFACIAL SURGERY GROUP OF COASTAL GEORGIA

Active
Other names
OMS of Coastal GA
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NICHOLAS THEODOTOU DDS (ORAL SURGEON)
(912) 600-6060
Entity
Organization

Contact information

Practice address
506 US HIGHWAY 80 W, POOLER, GA 31322-2104
(912) 600-6060
Mailing address
506 US HIGHWAY 80 W, POOLER, GA 31322-2104
(912) 600-6060

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Enumeration date
07/21/2021
Last updated
07/21/2021
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