| NPI | 1114486230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO ANN RICE Credentialing Director 470-881-8679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-11-28 |