| Ga Southern Dental Ppo | |
|
1000 Peachtree Industrial Blvd Ste 10 Suwanee GA 30024-1977 | |
| (770) 614-4666 | |
| Not Available |
| Full Name | Ga Southern Dental Ppo |
|---|---|
| Speciality | Dentist |
| Location | 1000 Peachtree Industrial Blvd Ste 10, Suwanee, 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 Ppo 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: (469) 596-6137 | Ga Southern Dental Ppo 1000 Peachtree Industrial Blvd Ste 10 Suwanee GA 30024-1977 Ph: (770) 614-4666 |
| NPI Number | 1417783291 |
|---|---|
| Provider Enumeration Date | 09/10/2024 |
| Last Update Date | 09/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417783291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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