Ga Southern Dental Ppo | |
950 Ga Highway 122 W Hahira GA 31632-1061 | |
(229) 588-8858 | |
Not Available |
Full Name | Ga Southern Dental Ppo |
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Speciality | Dentist |
Location | 950 Ga Highway 122 W, Hahira, 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 |
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Ga Southern Dental Ppo 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: (469) 596-6137 | Ga Southern Dental Ppo 950 Ga Highway 122 W Hahira GA 31632-1061 Ph: (229) 588-8858 |
NPI Number | 1346076122 |
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Provider Enumeration Date | 09/10/2024 |
Last Update Date | 09/10/2024 |
Identifier | Type | State | Issuer |
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1346076122 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | (* (Not Available)) | Primary |