AVALA DENTAL PROVIDERS,LLC
Managed Care Organizations in Lilburn, GA

License number
Georgia DN014034
Category
Managed Care Organizations
Type
Point of Service
Owner
Name: MS. TIFFANY N JAMISON DMD
Title: OWNER
Phone: (770) 696-4144
Address
Address
629 A Beaver Ruin Rd, Lilburn, GA 30047
National Provider ID: 1851729883
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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AVALA DENTAL PROVIDERS, LLC

629 Beaver Ruin Rd Nw - SUITE A, Lilburn, GA 30047

Registration:
Mar 9, 2011
State ID:
11018983
Business type:
Domestic Limited Liability Company
Agent:
Tiffany N Jamison,629 Beaver Ruin Rd Nw - SUITE A, Lilburn, GA (Physical)

Managed Care Organizations licenses in Georgia




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