Organization
GA SOTHERN DENTAL PPO
Active
Parent organization
GA SOTHERN DENTAL PPO
Other names
Natural Smiles Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
GA SOTHERN DENTAL PPO
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
3911 MARY ELIZA TRCE NW STE 100, MARIETTA, GA 30064-1087
(770) 362-6417
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
09/10/2024
Last updated
09/10/2024
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