Gregory M Thackston, Dmd,magd,llc

NPI #1811168909 in Douglas, Georgia

Provider Information

NPI Number: 1811168909
Entity Type: Organization
Organization Name: Gregory M Thackston, Dmd,magd,llc
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 17, 2008
Last Updated: Mar 17, 2008

Practice Location

Address: 506 MADISON AVE N
City: Douglas
State: Georgia
ZIP Code: 31533-4616
Phone: (912) 384-7200

Authorized Official

Name: DARILYN THACKSTON
Title: OFFICE MANAGER
Phone: (912) 384-7200

Specialties & Taxonomy Codes

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

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