| NPI | 1184845273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY LEON DIVERSI President 770-996-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA 6518) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |