Organization
SOUTHERN SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANLEY JASON HICKMAN D.M.D. (OWNER/DENTIST)
(478) 994-6473
Entity
Organization
Contact information
Practice address
275 N FRONTAGE RD, FORSYTH, GA 31029-9556
(478) 994-6473
Mailing address
275 N FRONTAGE RD, FORSYTH, GA 31029-9556
(478) 994-6473
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011865
GA
Other
Enumeration date
02/10/2012
Last updated
02/10/2012
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