| NPI | 1073221107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE CARIDE Credentialing Manager 470-207-3264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2022-11-08 |