Organization
PINE MOUNTAIN FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIDNEY DAUSTER HARDEN III D.M.D. (DENTIST)
(706) 663-2272
Entity
Organization
Contact information
Practice address
8944 HAMILTON ROAD, PINE MOUNTAIN, GA 31822
(706) 663-2272
(706) 663-2075
Mailing address
P.O. BOX 1176, PINE MOUNTAIN, GA 31822-4707
(706) 663-2272
(706) 663-2075
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DNO08005
GA
122300000X
Dentist
Primary
DNO12733
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000045295A
—
GA
05
—
594312970B
—
GA
Enumeration date
01/25/2010
Last updated
01/25/2010
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