| NPI | 1114059706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENT M MATTISON President 770-972-4666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN008284) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2020-08-22 |