| NPI | 1245507292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON S EAGLIN Owner 770-418-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013169) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013169) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |