| NPI | 1063564078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL I NETTLES President 770-997-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 6742) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 11589) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-09-11 |