Individual
DR. RODRIGO LORENZO URIBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
613 E GRADY ST, STATESBORO, GA 30458-5104
(912) 764-5435
(912) 764-9789
Mailing address
613 EAST GRADY STREET, P.O.BOX 1408, STATESBORO, GA 30459-1408
(912) 764-5435
(912) 764-9789
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN011060
GA
174400000X
Specialist
DN011060
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000514489A
—
GA
Enumeration date
07/26/2006
Last updated
10/30/2018
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