| NPI | 1225473630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALLAS H MARGESON President 229-985-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: GA GA11010) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-04-30 |