Provider Demographics
NPI:1104193531
Name:LINKSTON T CRYER DDS PC
Entity Type:Organization
Organization Name:LINKSTON T CRYER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINKSTON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CRYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-563-0327
Mailing Address - Street 1:3311 GENTIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5626
Mailing Address - Country:US
Mailing Address - Phone:706-563-0327
Mailing Address - Fax:706-563-0611
Practice Address - Street 1:3311 GENTIAN BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5626
Practice Address - Country:US
Practice Address - Phone:706-563-0327
Practice Address - Fax:706-563-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012488302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003113095AMedicaid