| NPI | 1083338685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CHONG Managing Member 770-854-2424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |