| NPI | 1134241714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L BASS Dentist 770-683-6030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN012975) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2017-07-14 |