| NPI | 1013558766 |
|---|---|
| Former Legal Business Name | GALLERIA DENTAL |
| Entity Type | Organization |
| Authorized Contact | KELLY GRAVES GUTHRIE Dentist 205-988-5858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2019-10-03 |