Organization
VAN TUYL DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE L DICKERSON (OFFICE MANAGER)
(770) 345-6600
Entity
Organization
Contact information
Practice address
929 COVE RD, SUITE F, JASPER, GA 30143-4444
(706) 692-3759
Mailing address
929 COVE RD, SUITE F, JASPER, GA 30143-4444
(706) 692-3759
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013002
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841686753
—
GA
Enumeration date
05/11/2009
Last updated
05/11/2009
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