| Bennett & Maxwell Family Dentistry | |
|
2415 Andover Dr Valdosta GA 31602-1280 | |
| (229) 671-1900 | |
| (229) 671-1999 |
| Full Name | Bennett & Maxwell Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 2415 Andover Dr, Valdosta, Georgia |
| Authorized Official Name and Position | Douglas Courtney Maxwell (OWNER) |
| Authorized Official Contact | 2296711900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bennett & Maxwell Family Dentistry 2415 Andover Dr Valdosta GA 31602-1280 Ph: (229) 671-1900 | Bennett & Maxwell Family Dentistry 2415 Andover Dr Valdosta GA 31602-1280 Ph: (229) 671-1900 |
| NPI Number | 1417108366 |
|---|---|
| Provider Enumeration Date | 10/08/2008 |
| Last Update Date | 10/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417108366 | NPI | - | NPPES |
| 000961276A | Medicaid | GA | |
| 000963256A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 11562 (Georgia) | Primary |
| 122300000X | Dentist | 11534 (Georgia) | Secondary |
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