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Organization
GA OMS SDS PC
Active
Organization
GA OMS SDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE DASCH (SR. DIRECTOR OF CREDENTIALING)
(504) 638-0303
Entity
Organization
Contact information
Practice address
1380 PEACHTREE INDUSTRIAL BLVD STE 100, SUWANEE, GA 30024-3793
(770) 232-1191
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(504) 638-0303
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/14/2025
Last updated
08/14/2025
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