Organization
LIFE BRIDGE DENTAL GA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH NEIL SULLIVAN (DIRECTOR RCM)
(615) 601-5250
Entity
Organization
Contact information
Practice address
675 PONCE DE LEON AVE NE, ATLANTA, GA 30308-1884
(212) 686-3686
(615) 468-0325
Mailing address
8 CITY BLVD STE 203, NASHVILLE, TN 37209-2559
(212) 686-3686
(615) 468-0325
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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