Provider Demographics
NPI:1235340852
Name:DITSLEAR, CYNTHIA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:S
Last Name:DITSLEAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 BAKERS FERRY TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4924
Mailing Address - Country:US
Mailing Address - Phone:706-651-0641
Mailing Address - Fax:
Practice Address - Street 1:3001 GORDON HWY
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3808
Practice Address - Country:US
Practice Address - Phone:706-855-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist