| NPI | 1093411910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN A WALLS President/Dentist 770-813-0079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2023-05-02 |