Organization
PARKSIDE DENTAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI PARKS (FRONT OFFICE)
(770) 487-8882
Entity
Organization
Contact information
Practice address
410 STEVENS ENTRY, PEACHTREE CITY, GA 30269-4050
(770) 487-8882
(770) 486-9469
Mailing address
410 STEVENS ENTRY, PEACHTREE CITY, GA 30269-4050
(770) 487-8882
(770) 486-9469
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
8697
GA
Other
Enumeration date
01/24/2014
Last updated
01/24/2014
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