| NPI | 1003296633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC BRANDON ALLRED Part Owner 770-946-3576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA DN014960) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-11 |