Organization
MONTICELLO FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER LIPHAM DMD (OWNER/AGENT)
(706) 468-6394
Entity
Organization
Contact information
Practice address
458 W WASHINGTON ST, MONTICELLO, GA 31064-1368
(706) 468-6394
(706) 468-8113
Mailing address
458 W WASHINGTON ST, MONTICELLO, GA 31064-1368
(706) 468-6394
(706) 468-8113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003236116C
—
GA
Enumeration date
12/04/2023
Last updated
12/04/2023
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