| NPI | 1114017530 |
|---|---|
| Other Name | THOMAS R BRODERICK ROBERT A VAUGHT MARK W DUSEK |
| Entity Type | Organization |
| Authorized Contact | THOMAS R BRODERICK Owner Partner 912-355-7022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN012058) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN010006) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN011121) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2020-08-22 |