| NPI | 1194908848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM GOULD LONG Owner 706-737-0133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA dn009950) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2007-12-17 |