| NPI | 1194155986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS JOHNSON Owner 770-704-6987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013366) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA DN014617) |
| 1223G0001X Dentist, General Practice (Licence: GA DN014219) | |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |