| NPI | 1104904036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN CHARLES TUCKER President 770-923-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 10864) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |