| NPI | 1013086248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RESA JOHNELLE ROBERTS Corporate Officer 404-556-1393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN010168) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012459) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN056718) | |
| 124Q00000X Dental Hygienist (Licence: GA DH007395) | |
| 122300000X Dentist (Licence: GA DN013502) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2010-09-29 |