| NPI | 1093819591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNIE CLEVELAND EVANS Dentist/Owner 770-229-1490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 8495) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-08-22 |