| NPI | 1073516662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN BENNINGER Hipaa Compliance Officer 404-266-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA GA8628 GA10187GA9232) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-08-22 |