| NPI | 1336570837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA KOCH Dentist 478-923-6449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN010803) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013676) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2013-12-09 |