Provider Demographics
NPI:1841550720
Name:THOMASVILLE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:THOMASVILLE DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MARABLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-985-5092
Mailing Address - Street 1:307 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768
Mailing Address - Country:US
Mailing Address - Phone:229-985-5092
Mailing Address - Fax:229-985-0138
Practice Address - Street 1:307 5TH ST SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-985-5092
Practice Address - Fax:229-985-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0109091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty