| NPI | 1124554142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A SNOW Credentialing COO Rdinator 404-410-1340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-12-01 |