Provider Demographics
NPI:1598140600
Name:GOLDEN ISLES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:GOLDEN ISLES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-882-4040
Mailing Address - Street 1:2475 VILLAGE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6728
Mailing Address - Country:US
Mailing Address - Phone:912-882-4040
Mailing Address - Fax:912-882-3514
Practice Address - Street 1:2475 VILLAGE DR
Practice Address - Street 2:SUITE 114
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6728
Practice Address - Country:US
Practice Address - Phone:912-882-4040
Practice Address - Fax:912-882-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty