| NPI | 1154788313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERIDITH LONG DAUTOVIC Managing Member 404-983-0237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN012254) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |