Provider Demographics
NPI:1972882900
Name:PEDIATRIC DENTISTRY OF SAVANNAH, LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF SAVANNAH, LLC
Other - Org Name:PEDIATRIC DENTISTRY OF SAVANNAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-349-4021
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:BUILDING #6
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-349-4021
Mailing Address - Fax:912-349-5717
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:BUILDING #6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-349-4021
Practice Address - Fax:912-349-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty