| NPI | 1104937010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYRA K AYALA RUBIO Pediatric Dentist 678-595-6470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 7892) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8103) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |