Provider Demographics
NPI:1912506700
Name:MIDDLE GA CENTER FOR COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:MIDDLE GA CENTER FOR COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:HAYSLIP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-929-2190
Mailing Address - Street 1:1295 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5582
Mailing Address - Country:US
Mailing Address - Phone:478-929-2190
Mailing Address - Fax:478-922-6496
Practice Address - Street 1:1295 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5582
Practice Address - Country:US
Practice Address - Phone:478-929-2190
Practice Address - Fax:478-922-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty