Provider Demographics
NPI:1316184575
Name:DORITY, DAVID S (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:DORITY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 FORD AVE
Mailing Address - Street 2:2-A ST. JOSEPH MEDICAL PLAZA
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-8804
Mailing Address - Country:US
Mailing Address - Phone:912-756-3880
Mailing Address - Fax:912-756-3516
Practice Address - Street 1:10015 FORD AVE
Practice Address - Street 2:2-A ST. JOSEPH MEDICAL PLAZA
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8804
Practice Address - Country:US
Practice Address - Phone:912-756-3880
Practice Address - Fax:912-756-3516
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist