| NPI | 1255464384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN SHORT Owner 770-781-8650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011242) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014775) |
| 122300000X Dentist (Licence: GA Dn015174) | |
| 122300000X Dentist | |
| 1223G0001X Dentist, General Practice (Licence: GA DN012306) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN011760) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN012514) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN015212) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN011424) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2018-03-17 |