ORAL AN IMPLANT SURGERY SPECIALISTS PC FAYETTEVILLE, GA

Contact Information

ORAL AN IMPLANT SURGERY SPECIALISTS, PC

1260 HIGHWAY 54 W
SUITE 200
FAYETTEVILLE, GA 30214-4514

Phone: 770-461-2101
Fax: 770-460-1292
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Oral & Maxillofacial Surgery	204E00000X	02	Physician/General Surgery

Indicates primary specialty

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NPI Profile & details for ORAL AN IMPLANT SURGERY SPECIALISTS PC · (Female)

NPI #	`1396094074`
Status	Active
Credentials
Entity	Individual
Enumeration date	09/10/2012
Last updated	05/10/2013 - About 13 years ago
Sole proprietor ¹	Not specified
Identifiers	GA License # 007973 GA Medicaid 000189351B
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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ORAL AN IMPLANT SURGERY SPECIALISTS PCOral & Maxillofacial Surgery

Contact Information

Specialty

Oral & Maxillofacial Surgery

NPI Profile & details for ORAL AN IMPLANT SURGERY SPECIALISTS PC · (Female)

Reviews for ORAL AN IMPLANT SURGERY SPECIALISTS, PC

ORAL AN IMPLANT SURGERY SPECIALISTS PC
Oral & Maxillofacial Surgery