Organization
MCGOVERN DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN MCGOVERN D.M.D (OWNER)
(912) 384-1306
Entity
Organization
Contact information
Practice address
1370 GORDON ST W, DOUGLAS, GA 31533-3432
(912) 384-1306
(912) 384-1308
Mailing address
1370 GORDON ST W, DOUGLAS, GA 31533-3432
(912) 384-1306
(912) 384-1308
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013714
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003106996A
—
GA
Enumeration date
08/30/2011
Last updated
08/30/2011
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