Provider Demographics
NPI:1447422787
Name:DEBBIE L. DISMUKE D.M.D.,P.C.
Entity Type:Organization
Organization Name:DEBBIE L. DISMUKE D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-384-2277
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1266
Mailing Address - Country:US
Mailing Address - Phone:912-384-2277
Mailing Address - Fax:912-384-7543
Practice Address - Street 1:1305 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2209
Practice Address - Country:US
Practice Address - Phone:912-384-2277
Practice Address - Fax:912-384-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty