| NPI | 1346606076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE CAVASIN Manager Provider Enrollment 404-785-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2025-10-17 |