Organization
SAVANNAH SMILES YOUTH DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (DIRECTOR, LICENSING & CREDENTIALING)
(912) 443-6013
Entity
Organization
Contact information
Practice address
2127 E VICTORY DR, SUITE #2, SAVANNAH, GA 31404-3917
(912) 443-6013
(912) 443-6014
Mailing address
2127 E VICTORY DR, SAVANNAH, GA 31404-3917
(912) 443-6013
(912) 443-6014
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1888552
UNITED CONCORDIA
GA
05
—
401680528A
—
GA
01
—
539121
AVESIS
GA
05
—
ZAG977
—
SC
Enumeration date
02/18/2006
Last updated
03/26/2015
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