Healthcare Provider Details

I. General information

NPI: 1942752316
Provider Name (Legal Business Name): VSM ABERDEEN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTHLAKE DR
PEACHTREE CITY GA
30269-3524
US

IV. Provider business mailing address

112 TOWNPARK DR NW STE 70
KENNESAW GA
30144-3740
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-8298
  • Fax:
Mailing address:
  • Phone: 404-410-1340
  • Fax: 404-410-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNI SNOW
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 404-410-1340