| NPI | 1063969368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL WALKER Credentialing Manager 770-744-4522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2021-05-11 |