| NPI | 1134405848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE DENNEY Owner 770-716-2701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013169) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013169) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2012-05-10 |