| NPI | 1053714766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNINE BARTCH Credentialing Manager 404-389-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401414164) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2014-10-08 |