Provider Demographics
NPI:1821144882
Name:T. DALE TWILLEY, D.M.D., P.C.
Entity Type:Organization
Organization Name:T. DALE TWILLEY, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:TWILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-886-1424
Mailing Address - Street 1:735 BIG A RD S
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-3166
Mailing Address - Country:US
Mailing Address - Phone:706-886-1424
Mailing Address - Fax:706-282-4061
Practice Address - Street 1:735 BIG A RD S
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3166
Practice Address - Country:US
Practice Address - Phone:706-886-1424
Practice Address - Fax:706-282-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty