Dyess Parkway Dental, LLC

NPI #1275898900 in Augusta, Georgia

Provider Information

NPI Number: 1275898900
Entity Type: Organization
Organization Name: Dyess Parkway Dental, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 9, 2012
Last Updated: Jul 9, 2012

Practice Location

Address: 4045 JIMMIE DYESS PKWY STE 103
City: Augusta
State: Georgia
ZIP Code: 30909-9492
Phone: (706) 868-4200

Authorized Official

Name: DR. FRED M HANNAN SR., D.D.S.
Title: DENTIST
Phone: (706) 868-4200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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