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Organization
PROVIDENCE DENTAL SPA OF NEWNAN, LLC
Active
Organization
PROVIDENCE DENTAL SPA OF NEWNAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JASON MANN DMD (MANAGING PARTNER)
(770) 550-7741
Entity
Organization
Contact information
Practice address
166 JEFFERSON PKWY, NEWNAN, GA 30263-5822
(770) 252-1300
(770) 252-1763
Mailing address
225 N MACON ST, MACON, GA 31210-6562
(478) 733-0857
(478) 254-5709
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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