| NPI | 1225255573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CLELAND FRASER Periodontics 678-423-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA dn012684) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |