| NPI | 1316202872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE NA Dentist 770-921-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN10984) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN014407) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013700) | |
| 1223P0300X Dentist, Periodontics (Licence: GA DN013014) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2013-01-11 |