| Kid's Zone Dentistry, Llc | |
|
307 Church St Suite A Lagrange GA 30240-2700 | |
| (706) 882-0591 | |
| (706) 845-9546 |
| Full Name | Kid's Zone Dentistry, Llc |
|---|---|
| Speciality | Dentist |
| Location | 307 Church St, Lagrange, Georgia |
| Authorized Official Name and Position | Laura L Webb (OFFICE MANAGER) |
| Authorized Official Contact | 7068820591 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kid's Zone Dentistry, Llc 307 Church St Suite A Lagrange GA 30240-2700 Ph: (706) 882-0591 | Kid's Zone Dentistry, Llc 307 Church St Suite A Lagrange GA 30240-2700 Ph: (706) 882-0591 |
| NPI Number | 1073975868 |
|---|---|
| Provider Enumeration Date | 03/22/2016 |
| Last Update Date | 03/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073975868 | NPI | - | NPPES |
| 000136848D | Medicaid | GA | |
| 003148248A | Medicaid | GA | |
| 191678896B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN008745 (Georgia) | Secondary |
| 122300000X | Dentist | DN014796 (Georgia) | Secondary |
| 122300000X | Dentist | (Georgia) | Primary |
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