| NPI | 1225495245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE KOSATER Manager 478-477-1228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN009476) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012405) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2016-01-21 |