Provider Demographics
NPI:1841755287
Name:SOUTHSIDE EMERGENCY DENTAL CENTER LLC
Entity Type:Organization
Organization Name:SOUTHSIDE EMERGENCY DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LUCREE
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-484-6613
Mailing Address - Street 1:10515 WHITE BLUFF RD.
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-925-6613
Mailing Address - Fax:912-925-6657
Practice Address - Street 1:10515 WHITE BLUFF RD.
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-925-6613
Practice Address - Fax:912-925-6657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE L. SKINNER, D.M.D, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty