Organization
MIDDLE GEORGIA ORAL AND MAXILLOFACIAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENDON WILLIAM SMALLEY III DMD (ORAL SURGEON)
(706) 340-3408
Entity
Organization
Contact information
Practice address
117 S CALHOUN ST, DUBLIN, GA 31021-5245
(706) 340-3408
Mailing address
401 CREST DR, BIRMINGHAM, AL 35209-5525
(478) 290-7275
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN014148
STATE LICENSE
GA
Enumeration date
07/01/2019
Last updated
07/01/2019
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