| NPI | 1346907938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MOORE Organizer 678-464-9773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2021-11-18 |