| NPI | 1336311414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK PHILLIP MOORE President 770-297-7888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN011706) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2008-03-28 |