| NPI | 1164289377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY HANCOCK Credentialing 770-356-0489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-03-04 |