| NPI | 1316096431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA COOPER Insurance Coordinator 229-293-1360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 010688) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-08-22 |