Provider Demographics
NPI:1770685141
Name:VIDALIA DENTAL ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:VIDALIA DENTAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-537-2238
Mailing Address - Street 1:1618 MEADOWS LN
Mailing Address - Street 2:PO BOX 363
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0363
Mailing Address - Country:US
Mailing Address - Phone:912-537-2238
Mailing Address - Fax:912-537-0979
Practice Address - Street 1:1618 MEADOWS LANE
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30475-0363
Practice Address - Country:US
Practice Address - Phone:912-537-2238
Practice Address - Fax:912-537-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0083301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty