Provider Demographics
NPI:1275924508
Name:DOTY, GEORGIA (RDH)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:DOTY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 SW JIM WITT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-2411
Mailing Address - Country:US
Mailing Address - Phone:352-333-9898
Mailing Address - Fax:
Practice Address - Street 1:126 NW 76TH DR STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6675
Practice Address - Country:US
Practice Address - Phone:352-333-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH17203124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist