Provider Demographics
NPI:1932212057
Name:CAROL S ROHDE DDS MS AND TIMOTHY R ROHDE DDS PC
Entity Type:Organization
Organization Name:CAROL S ROHDE DDS MS AND TIMOTHY R ROHDE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:229-883-5115
Mailing Address - Street 1:1503 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707
Mailing Address - Country:US
Mailing Address - Phone:229-883-5115
Mailing Address - Fax:229-878-6001
Practice Address - Street 1:1503 THIRD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-883-5115
Practice Address - Fax:229-878-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114891223E0200X
GA0116111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty