| Pine Mountain Family Dentistry, Llc | |
|
8944 Hamilton Road Pine Mountain GA 31822 | |
| (706) 663-2272 | |
| (706) 663-2075 |
| Full Name | Pine Mountain Family Dentistry, Llc |
|---|---|
| Speciality | Dentist |
| Location | 8944 Hamilton Road, Pine Mountain, Georgia |
| Authorized Official Name and Position | Sidney Dauster Harden (DENTIST) |
| Authorized Official Contact | 7066632272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Mountain Family Dentistry, Llc P.o. Box 1176 Pine Mountain GA 31822-4707 Ph: (706) 663-2272 | Pine Mountain Family Dentistry, Llc 8944 Hamilton Road Pine Mountain GA 31822 Ph: (706) 663-2272 |
| NPI Number | 1780915165 |
|---|---|
| Provider Enumeration Date | 01/25/2010 |
| Last Update Date | 01/25/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780915165 | NPI | - | NPPES |
| 000045295A | Medicaid | GA | |
| 594312970B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DNO08005 (Georgia) | Secondary |
| 122300000X | Dentist | DNO12733 (Georgia) | Primary |