| NPI | 1336718212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNALDO T REESE CEO 770-949-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |