Provider Demographics
NPI:1104186329
Name:SAVANNAH DENTAL ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:SAVANNAH DENTAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-234-5003
Mailing Address - Street 1:413 W DUFFY ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-6716
Mailing Address - Country:US
Mailing Address - Phone:912-234-5003
Mailing Address - Fax:912-234-2844
Practice Address - Street 1:413 W DUFFY ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6716
Practice Address - Country:US
Practice Address - Phone:912-234-5003
Practice Address - Fax:912-234-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty