| NPI | 1104285535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUCHIR PATEL Manager 770-914-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: GA DN014542) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |