| Sweetgums Dental Llc | |
|
1435 54th St Suite 100a Columbus GA 31904-4998 | |
| (706) 507-9132 | |
| (706) 507-9135 |
| Full Name | Sweetgums Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 1435 54th St, Columbus, Georgia |
| Authorized Official Name and Position | Laretha Urett Lockhart (OWNER/DENTIST) |
| Authorized Official Contact | 7065079132 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sweetgums Dental Llc 1435 54th St Suite 100a Columbus GA 31904-4998 Ph: (706) 507-9132 | Sweetgums Dental Llc 1435 54th St Suite 100a Columbus GA 31904-4998 Ph: (706) 507-9132 |
| NPI Number | 1477859387 |
|---|---|
| Provider Enumeration Date | 02/10/2011 |
| Last Update Date | 02/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477859387 | NPI | - | NPPES |
| 355358613B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN013438 (Georgia) | Primary |
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