| NPI | 1023777349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO ANN RICE Credentialing Manager 470-881-8679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2021-12-14 |