| NPI | 1235354895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE H. RAUSCH Secretary Treasurer 770-931-3388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA 9829) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA 9656) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2009-07-13 |