| NPI | 1184059073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEYSRA M WASHINGTON Owner/Dentist 770-761-5690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013140) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2014-02-07 |