| NPI | 1073431144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNI TOMLINSON Credentialing And Enrollment 470-552-1823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-07-07 |
| Last Update Date | 2026-07-07 |