Organization
CCSD-PC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA TIDWELL (INSURANCE MANAGER)
(770) 995-1957
Entity
Organization
Contact information
Practice address
5075 PEACHTREE PKWY STE 105B, PEACHTREE CORNERS, GA 30092-6506
(678) 288-4888
Mailing address
5075 PEACHTREE PKWY STE 105B, PEACHTREE CORNERS, GA 30092-6506
(678) 288-4888
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/16/2026
Last updated
02/16/2026
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