| NPI | 1073794632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETT LYNN JORGENSEN President 770-932-0992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013591) |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2007-11-23 |