Provider Demographics
NPI:1417527730
Name:SHORT, SAVANNAH LAUREN (DMD)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:LAUREN
Last Name:SHORT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 AVERY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-2703
Mailing Address - Country:US
Mailing Address - Phone:404-583-8955
Mailing Address - Fax:
Practice Address - Street 1:2419 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4955
Practice Address - Country:US
Practice Address - Phone:770-977-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1223881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice