| NPI | 1205295292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN SMITH CFO 770-231-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2025-01-21 |