| NPI | 1164490918 |
|---|---|
| Former Legal Business Name | CENTER FOR PEDIATRIC DENTISTRY, PC |
| Entity Type | Organization |
| Authorized Contact | MARY SHIRLEY Administrator 706-855-8989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 11680) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-01-18 |