Organization
GA PRIME DENTAL, L.L.C.
Active
Other names
Aspen Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LA DUC (PROVIDER RELATIONS)
(315) 454-6000
Entity
Organization
Contact information
Practice address
17 PARKWAY DR, FORT OGLETHORPE, GA 30742-4249
(706) 944-3122
(706) 861-7946
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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