Provider Demographics
NPI:1336900166
Name:PEDIATRIC DENTISTRY OF NEWNAN, LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF NEWNAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-836-9378
Mailing Address - Street 1:2401 NEWNAN CROSSING BLVD E STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2409
Mailing Address - Country:US
Mailing Address - Phone:770-251-5777
Mailing Address - Fax:
Practice Address - Street 1:2401 NEWNAN CROSSING BLVD E STE 210
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2409
Practice Address - Country:US
Practice Address - Phone:770-251-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty