| NPI | 1093217085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNON W GREENE President 470-705-0788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 8312) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA 8312) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2023-12-11 |