Provider Demographics
NPI:1942752316
Name:VSM ABERDEEN DENTAL LLC
Entity Type:Organization
Organization Name:VSM ABERDEEN DENTAL LLC
Other - Org Name:ABERDEEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-410-1340
Mailing Address - Street 1:112 TOWNPARK DR NW STE 70
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3740
Mailing Address - Country:US
Mailing Address - Phone:404-410-1340
Mailing Address - Fax:404-410-1345
Practice Address - Street 1:300 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3524
Practice Address - Country:US
Practice Address - Phone:770-487-8298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty