| NPI | 1144766510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL COLLIER Chief Operating Officer 706-564-0691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2913) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 10664) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-02-24 |