| NPI | 1104583343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A CLINE Credentialing Specialist 678-986-7116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2021-11-23 |