| NPI | 1245760859 |
|---|---|
| Doing Business As | LOST MOUNTAIN DENTAL @ DUE WEST |
| Entity Type | Organization |
| Authorized Contact | MICHAEL MULKEY Owner, Dentist 770-425-4001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-21 |