Organization
ADVANCED DENTAL ARTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMER MUFID OTHMAN D.D.S. (OWNER)
(478) 207-6939
Entity
Organization
Contact information
Practice address
4705 NORTHSIDE DR, SUITE 100, MACON, GA 31210-1698
(478) 207-6939
(478) 254-9638
Mailing address
4705 NORTHSIDE DR, SUITE 100, MACON, GA 31210-1698
(478) 207-6939
(478) 254-9638
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN014686
GA
Other
Enumeration date
04/09/2015
Last updated
04/09/2015
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