| NPI | 1265731442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAJUANA PEARLDEALIA FARREY Dental Director 229-890-3908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013880) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2022-06-29 |