| Ga Sothern Dental Ppo | |
|
3911 Mary Eliza Trce Nw Ste 100 Marietta GA 30064-1087 | |
| (770) 362-6417 | |
| Not Available |
| Full Name | Ga Sothern Dental Ppo |
|---|---|
| Speciality | Dentist |
| Location | 3911 Mary Eliza Trce Nw Ste 100, Marietta, Georgia |
| Authorized Official Name and Position | Erika Melissa Menjivar (SR. CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4695966137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ga Sothern Dental Ppo 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: (469) 596-6137 | Ga Sothern Dental Ppo 3911 Mary Eliza Trce Nw Ste 100 Marietta GA 30064-1087 Ph: (770) 362-6417 |
| NPI Number | 1750117537 |
|---|---|
| Provider Enumeration Date | 09/10/2024 |
| Last Update Date | 09/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750117537 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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