Provider Demographics
NPI:1023171287
Name:WAYNE S. MARIS, DDS, PC
Entity type:Organization
Organization Name:WAYNE S. MARIS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-423-9237
Mailing Address - Street 1:171 PERRY HOUSE RD
Mailing Address - Street 2:PO DRAWER 1009
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8837
Mailing Address - Country:US
Mailing Address - Phone:229-423-9237
Mailing Address - Fax:
Practice Address - Street 1:171 PERRY HOUSE RD
Practice Address - Street 2:PO DRAWER 1009
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8837
Practice Address - Country:US
Practice Address - Phone:229-423-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty