| NPI | 1134497589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA G. MAGUIRE Credentialing Manager 404-389-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |