Provider Demographics
NPI:1568536522
Name:JAMES T MAHOLICK DMD
Entity Type:Organization
Organization Name:JAMES T MAHOLICK DMD
Other - Org Name:MAHOLICK INNOVATIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MAHOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-494-1200
Mailing Address - Street 1:3081 WILLIAMS ROAD
Mailing Address - Street 2:UNIT B - 100
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909
Mailing Address - Country:US
Mailing Address - Phone:706-494-1200
Mailing Address - Fax:706-494-1333
Practice Address - Street 1:3081 WILLIAMS ROAD
Practice Address - Street 2:UNIT B - 100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:706-494-1200
Practice Address - Fax:706-494-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGADN012555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty