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Organization
PROVIDENCE DENTAL LLC
Active
Organization
PROVIDENCE DENTAL LLC
Active
Parent organization
PROVIDENCE DENTAL LLC
Other names
Inspire Dental Roswell
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE DENTAL LLC
Authorized official
HEATHER TAYLOR (DIRECTOR)
(478) 733-0857
Entity
Organization
Contact information
Practice address
225 N MACON ST, MACON, GA 31210-6562
(478) 733-0857
Mailing address
555 SUN VALLEY DR STE C3, ROSWELL, GA 30076-5621
(770) 643-9499
(770) 490-9499
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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