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Organization

PROVIDENCE DENTAL SPA OF NEWNAN, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PAUL JASON MANN DMD (MANAGING PARTNER)
(770) 550-7741
Entity
Organization

Contact information

Practice address
166 JEFFERSON PKWY, NEWNAN, GA 30263-5822
(770) 252-1300
(770) 252-1763
Mailing address
225 N MACON ST, MACON, GA 31210-6562
(478) 733-0857
(478) 254-5709

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
12/06/2021
Last updated
12/06/2021
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