Provider Demographics
NPI:1073886420
Name:GOLDEN ISLES CENTER FOR EXCEPTIONAL DENTISTRY, P.C.
Entity Type:Organization
Organization Name:GOLDEN ISLES CENTER FOR EXCEPTIONAL DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-264-5550
Mailing Address - Street 1:110 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6743
Mailing Address - Country:US
Mailing Address - Phone:912-264-5550
Mailing Address - Fax:912-264-5255
Practice Address - Street 1:110 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6743
Practice Address - Country:US
Practice Address - Phone:912-264-5550
Practice Address - Fax:912-264-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty