| NPI | 1295123685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY J LOOS Manager 770-345-8300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 10100) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |