Organization
PALMETTO FAMILY DENTAL OF PIKE COUNTY
Active
Other names
Palmetto Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN ALBERT BRUNSON DDS (PRESIDENT)
(770) 567-8000
Entity
Organization
Contact information
Practice address
15988 BARNESVILLE ST., ZEBULON, GA 30295
(770) 567-8000
(770) 567-8600
Mailing address
15988 BARNESVILLE ST., ZEBULON, GA 30295
(770) 567-8000
(770) 567-8600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN013693
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
685019718C
—
GA
Enumeration date
08/13/2013
Last updated
07/20/2022
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