| NPI | 1104186329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP A COOPER Office Manager 912-234-5003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 8412) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-05-22 |