Provider Demographics
NPI:1134543515
Name:COMPASSIONATE MOBILE DENTISTS OF GEORGIA
Entity type:Organization
Organization Name:COMPASSIONATE MOBILE DENTISTS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-952-7522
Mailing Address - Street 1:PO BOX 27328
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-7328
Mailing Address - Country:US
Mailing Address - Phone:478-952-7522
Mailing Address - Fax:
Practice Address - Street 1:3907 UPPER RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-3821
Practice Address - Country:US
Practice Address - Phone:478-952-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty