Provider Demographics
NPI:1861041113
Name:THOMASVILLE DENTAL CENTER
Entity Type:Organization
Organization Name:THOMASVILLE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:BURTHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-227-9070
Mailing Address - Street 1:396 LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-4822
Mailing Address - Country:US
Mailing Address - Phone:229-227-9070
Mailing Address - Fax:229-227-6299
Practice Address - Street 1:396 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4822
Practice Address - Country:US
Practice Address - Phone:229-227-9070
Practice Address - Fax:229-227-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty