| NPI | 1255416269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN ALLEN WOMBLE President 770-914-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 9213) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-08-22 |