| NPI | 1063527745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM C HURST Business Manager 912-285-1218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 007191) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 013177) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2013-09-26 |