Organization
YOUTH DENTISTRY OF MACON, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA S ZOELLER (VP, LEGAL LICENSING & CREDENTIALING)
(478) 781-4333
Entity
Organization
Contact information
Practice address
1536 EISENHOWER PKWY, MACON, GA 31206-3130
(478) 781-4333
(478) 781-4331
Mailing address
1536 EISENHOWER PKWY, MACON, GA 31206-3130
(478) 781-4333
(478) 781-4331
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1905601
UNITED CONCORDIA
GA
05
—
478300670A
—
GA
01
—
539109
AVESIS
GA
Enumeration date
02/18/2006
Last updated
09/06/2016
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