Organization
IDEALSMILE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAE H HAM DDS (PRESIDENT)
(706) 257-7374
Entity
Organization
Contact information
Practice address
2501 WHITTLESEY BLVD, SUITE B, COLUMBUS, GA 31909-3031
(706) 257-7374
(706) 257-7379
Mailing address
2501 WHITTLESEY BLVD, SUITE B, COLUMBUS, GA 31909-3031
(706) 257-7374
(706) 257-7379
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN013040
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
561235509C
—
GA
05
—
626075029C
—
GA
Enumeration date
10/28/2008
Last updated
10/28/2008
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