GA SOUTHERN DENTAL PPO

MARIETTA, GA
NPI1902695521
Entity TypeOrganization
Authorized ContactERIKA MELISSA MENJIVAR
Sr. Credentialing Specialist
469-596-6137
Organization Subpart ?Yes
Primary Taxonomy122300000X Dentist
Enumeration Date2025-05-01
Last Update Date2025-05-01
Business Address
GA SOUTHERN DENTAL PPO
365 VILLA RICA WAY SW
MARIETTA, GA 30064-5727
Phone number: 770-428-1999
Mailing Address
GA SOUTHERN DENTAL PPO
5830 GRANITE PKWY STE 780
PLANO, TX 75024-6775
Phone number:
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