Eaglin Dental Group, Fayetteville | |
692 Glynn St N Ste S Fayetteville GA 30214-6705 | |
(770) 716-2701 | |
(770) 716-2718 |
Full Name | Eaglin Dental Group, Fayetteville |
---|---|
Speciality | Dentist - General Practice |
Location | 692 Glynn St N Ste S, Fayetteville, Georgia |
Authorized Official Name and Position | Tracie Denney (OWNER) |
Authorized Official Contact | 7707162701 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Eaglin Dental Group, Fayetteville 692 Glynn St N Ste S Fayetteville GA 30214-6705 Ph: (770) 716-2701 | Eaglin Dental Group, Fayetteville 692 Glynn St N Ste S Fayetteville GA 30214-6705 Ph: (770) 716-2701 |
NPI Number | 1134405848 |
---|---|
Provider Enumeration Date | 10/26/2011 |
Last Update Date | 05/10/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134405848 | NPI | - | NPPES |
777472578D | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | DN013169 (Georgia) | Primary |
1223P0221X | Dentist - Pediatric Dentistry | DN013169 (Georgia) | Secondary |
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