Provider Demographics
NPI:1275525222
Name:MARIS, WAYNE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S
Last Name:MARIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PERRY HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8837
Mailing Address - Country:US
Mailing Address - Phone:229-423-9237
Mailing Address - Fax:229-423-7786
Practice Address - Street 1:171 PERRY HOUSE RD
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8837
Practice Address - Country:US
Practice Address - Phone:229-423-9237
Practice Address - Fax:229-423-7786
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist