| NPI | 1346898293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JACOMINO Director Of Payor Relations 770-916-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| 1223E0200X Dentist, Endodontics | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |