NPIMap

East Georgia Oral & Maxillofacial Surgery Center

Organization Active NPI Dental Clinic/Center · Statesboro, GA

NPI 1184946337 · NPPES record last updated Feb 15, 2010

Key facts

NPI
1184946337
Entity type
Organization (NPI type 2)
Primary specialty
Dental Clinic/Center 261QD0000X
License
11060 (GA)
Legal business name
EAST GEORGIA ORAL & MAXILLOFACIAL SURGERY CENTER
Practice address
613 E Grady St
Statesboro, GA 30458-5104
Phone
(912) 764-5435
Fax
(912) 764-9789
NPI assigned
Feb 15, 2010
Organization subpart
No

Authorized official

Name
Dr. Rodrigo Lorenzo Uribe, D.M.D. NPI 1811911977
Title
Owner
Phone
(912) 764-5435

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

613 E Grady St
Statesboro, GA 30458
Phone (912) 764-5435

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11060 GA Yes
Dental Clinic/Center 261QD0000X 012756 GA

Addresses

Primary practice location

613 E Grady St
Statesboro, GA 30458-5104

Mailing address

613 E Grady St
Statesboro, GA 30458-5104
Phone (912) 764-5435

Other identifiers

IdentifierTypeStateIssuer
478841397BMedicaidGA
000514489AMedicaidGA

Other providers in Statesboro, GA

All providers in Statesboro, GA · Dental Clinic/Center in Georgia

Sources for this page

Verify at the official NPI Registry.