| NPI | 1023133519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD KELLEY REAGIN, JR. CEO 229-244-4656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012569) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |