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Organization

WESTSIDE MANAGEMENT

Active
Other names
Westside Dental
Organization subpart
No

Provider details

NPI number
Authorized official
SHERRYL ANN ODONNELL (MGR)
(770) 499-7005
Entity
Organization

Contact information

Practice address
3515 DALLAS HWY STE. B, MARIETTA, GA 30064
(770) 499-7005
(770) 499-7081
Mailing address
3515 DALLAS HWY STE. B, MARIETTA, GA 30064
(770) 499-7005
(770) 499-7081

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
71012
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
65978
DELTA DENTAL OF GA.
GA
Enumeration date
04/24/2015
Last updated
04/24/2015
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