| Ccsd-pc, Llc | |
|
5075 Peachtree Pkwy Ste 105b Peachtree Corners GA 30092-6506 | |
| (678) 288-4888 | |
| Not Available |
| Full Name | Ccsd-pc, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5075 Peachtree Pkwy Ste 105b, Peachtree Corners, Georgia |
| Authorized Official Name and Position | Donna Tidwell (INSURANCE MANAGER) |
| Authorized Official Contact | 7709951957 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccsd-pc, Llc 5075 Peachtree Pkwy Ste 105b Peachtree Corners GA 30092-6506 Ph: (678) 288-4888 | Ccsd-pc, Llc 5075 Peachtree Pkwy Ste 105b Peachtree Corners GA 30092-6506 Ph: (678) 288-4888 |
| NPI Number | 1619820214 |
|---|---|
| Provider Enumeration Date | 02/16/2026 |
| Last Update Date | 02/16/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619820214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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