| NPI | 1013158484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JACOMINO Director Of Payor Relations 770-916-5036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223G0001X Dentist General Practice | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2022-08-19 |