Organization
GEORGIA DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WINKLER (REVENUE CYCLE MANAGER)
(717) 590-1513
Entity
Organization
Contact information
Practice address
101 N POINTE BLVD, SUITE 202, LANCASTER, PA 17601-4108
(717) 590-1513
Mailing address
PO BOX 782886, PHILADELPHIA, PA 19178-2886
(717) 590-1513
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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