| NPI | 1144812348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN CLINTON ELMORE Owner/Authorized Official 678-480-9808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2024-04-22 |