| NPI | 1033184643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL STUMP Director, Licensing & Credentialing 706-790-9302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2015-03-26 |