Provider Demographics
NPI:1689451049
Name:DENTAL CARE CENTER OF MACON, PC
Entity Type:Organization
Organization Name:DENTAL CARE CENTER OF MACON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-755-8366
Mailing Address - Street 1:3432 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-4902
Mailing Address - Country:US
Mailing Address - Phone:478-755-8366
Mailing Address - Fax:478-755-8399
Practice Address - Street 1:3432 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-4902
Practice Address - Country:US
Practice Address - Phone:478-755-8366
Practice Address - Fax:478-755-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty