Ga Southern Dental LLC

NPI #1285461749 in Alpharetta, Georgia

Provider Information

NPI Number: 1285461749
Entity Type: Organization
Organization Name: Ga Southern Dental LLC
Subpart: Yes (part of a larger organization)
Parent Organization: GA SOUTHERN DENTAL LLC
Primary Specialty: Dentist
Enumeration Date: Sep 18, 2024
Last Updated: Sep 18, 2024

Practice Location

Address: 4928 ATLANTA HWY
City: Alpharetta
State: Georgia
ZIP Code: 30004-2921
Phone: (678) 393-1868

Authorized Official

Name: ERIKA MELISSA MENJIVAR
Title: SR. CREDENTIALING SPECIALIST
Phone: (469) 596-6137

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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