Provider Demographics
NPI:1932126836
Name:FILLING STATION FAMILY DENTAL CENTERS, INC.
Entity Type:Organization
Organization Name:FILLING STATION FAMILY DENTAL CENTERS, INC.
Other - Org Name:RONNIE W. ARRINGTON,D.M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-435-5176
Mailing Address - Street 1:PO BOX 3821
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31706-3821
Mailing Address - Country:US
Mailing Address - Phone:229-435-5176
Mailing Address - Fax:229-435-0417
Practice Address - Street 1:1714 E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-2611
Practice Address - Country:US
Practice Address - Phone:229-435-5176
Practice Address - Fax:229-435-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000255428BMedicaid
GA000255428AMedicaid