NPI | 1114486230 |
---|---|
Entity Type | Organization |
Authorized Contact | TAMONIA LEONARD Credentialing Spec 678-244-4844 |
Organization Subpart ? | No |
Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
Additional Taxonomies | 261Q00000X Clinic/Center |
Enumeration Date | 2019-03-18 |
Last Update Date | 2019-03-18 |