Organization
GA SOUTHERN DENTAL PPO
Active
Parent organization
GA SOUTHERN DENTAL PPO
Other names
Collier Hills Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
GA SOUTHERN DENTAL PPO
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
857 COLLIER RD NW # 14, ATLANTA, GA 30318-2532
(404) 355-4952
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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