| NPI | 1093488132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER TOMLINSON Credentialing Specialist 678-986-7116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2021-07-26 |