| NPI | 1114182425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE CORNELL KEGLER Owner 770-536-6688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012376) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2008-07-25 |