| NPI | 1205939899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFONSO CARLOS FERNANDEZ Dentist 770-474-7223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 11980) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 14437) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2012-03-27 |