| NPI | 1063095842 |
|---|---|
| Former Legal Business Name | EVOLUTION DENTAL SURGERY CENTER |
| Entity Type | Organization |
| Authorized Contact | AMY CAMBA Prosthodontist 706-951-3147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2021-04-30 |