Organization
GA DENTISTRY SERVICES PC
Active
Other names
Aspen Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE LAUDERDALE DMD (DMD/INCORPORATOR)
(315) 454-6000
Entity
Organization
Contact information
Practice address
1430 HIGHWAY 20 W, MCDONOUGH, GA 30253-7305
(678) 537-6000
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13892
GA
Other
Enumeration date
03/29/2014
Last updated
03/29/2014
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