Provider Demographics
NPI:1518598325
Name:REDWOOD DENTAL OF GEORGIA PC
Entity Type:Organization
Organization Name:REDWOOD DENTAL OF GEORGIA PC
Other - Org Name:SMILE PARTNERS USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-842-3670
Mailing Address - Street 1:800 KIRTS BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4850
Mailing Address - Country:US
Mailing Address - Phone:248-842-3670
Mailing Address - Fax:586-991-1933
Practice Address - Street 1:800 KIRTS BLVD STE 650
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4850
Practice Address - Country:US
Practice Address - Phone:248-842-3670
Practice Address - Fax:586-991-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty