| NPI | 1114181138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL E. GANNON Owner/Dentist 770-297-0401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY DN013665) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: GA DN11839) |
| 1223D0001X Dentist, Dental Public Health (Licence: GA DN013644) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2024-05-06 |