Organization
GA SOUTHERN DENTAL LLC
Active
Parent organization
GA SOUTHERN DENTAL LLC
Other names
Midway Family & Cosmetic Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
GA SOUTHERN DENTAL LLC
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
4928 ATLANTA HWY, ALPHARETTA, GA 30004-2921
(678) 393-1868
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
(469) 596-6137
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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