| NPI | 1023301348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES P BROOKS Owner 229-723-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN007286) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014123) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |