Provider Demographics
NPI:1922593763
Name:MERANDI, OLIVIA JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:JO
Last Name:MERANDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 JOE FRANK HARRIS PKWY SE STE B
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2430
Mailing Address - Country:US
Mailing Address - Phone:470-274-2828
Mailing Address - Fax:470-274-2822
Practice Address - Street 1:791 JOE FRANK HARRIS PKWY SE STE B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2430
Practice Address - Country:US
Practice Address - Phone:470-274-2828
Practice Address - Fax:470-274-2822
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339811223G0001X
GADN015727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice