Provider Demographics
NPI:1891160602
Name:DENTAL CENTER OF ST SIMONS
Entity Type:Organization
Organization Name:DENTAL CENTER OF ST SIMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-7048
Mailing Address - Street 1:101 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS IS
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2606
Mailing Address - Country:US
Mailing Address - Phone:912-634-4890
Mailing Address - Fax:912-634-4892
Practice Address - Street 1:101 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:ST SIMONS IS
Practice Address - State:GA
Practice Address - Zip Code:31522-2606
Practice Address - Country:US
Practice Address - Phone:912-634-4890
Practice Address - Fax:912-634-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0118941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty