| Ga Southern Dental Llc | |
|
3298 Northside Dr Macon GA 31210-2553 | |
| (478) 475-1976 | |
| Not Available |
| Full Name | Ga Southern Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 3298 Northside Dr, Macon, 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 Southern Dental Llc 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: () - | Ga Southern Dental Llc 3298 Northside Dr Macon GA 31210-2553 Ph: (478) 475-1976 |
| NPI Number | 1053139519 |
|---|---|
| Provider Enumeration Date | 10/02/2024 |
| Last Update Date | 10/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053139519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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