Organization
SOUTHERN ORAL SURGERY PC
Active
Other names
Drs Gruskin Lucas & Ferrara PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC D FERRARA DDS (OWNER)
(770) 228-1010
Entity
Organization
Contact information
Practice address
614 S 8TH ST, GRIFFIN, GA 30224-4214
(770) 228-1010
(678) 692-0242
Mailing address
614 S 8TH ST, GRIFFIN, GA 30224-4214
(770) 228-1010
(678) 692-0242
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN012761
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN013416
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003109984A
—
GA
05
—
178058507A
—
GA
05
—
178058507B
—
GA
Enumeration date
07/12/2006
Last updated
10/12/2011
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