| NPI | 1225406960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA MARTIN Hr Manager 770-382-3536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2881) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 2881) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2017-05-10 |