Organization
VALDOSTA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN F TANNER DMD (DENTIST)
(229) 333-8484
Entity
Organization
Contact information
Practice address
2935 N ASHLEY ST, SUITE 130, VALDOSTA, GA 31602-1777
(229) 333-8484
Mailing address
2935 N ASHLEY ST, SUITE 130, VALDOSTA, GA 31602-1777
(229) 333-8484
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013182
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
827915201A
—
GA
Enumeration date
03/16/2009
Last updated
03/16/2009
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