| NPI | 1265854194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ALLEN Owner 678-491-1192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN012334) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30019014) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2016-09-26 |