| NPI | 1275662439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE WILSON CFO 912-262-0542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 010583) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DNO12937) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2011-07-20 |