Organization
PARKSIDE DENTAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN L MATLAGA DDS GEN PTR DDS (OWNER)
(770) 487-8882
Entity
Organization
Contact information
Practice address
410 STEVENS ENTRY, PEACHTREE CITY, GA 30269
(770) 487-8882
(770) 486-9469
Mailing address
410 STEVENS ENTRY, PO BOX 2606, PEACHTREE CITY, GA 30269
(770) 487-8882
(770) 486-9469
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
GA8697
GA
Other
Enumeration date
09/26/2006
Last updated
04/20/2008
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