| NPI | 1356003917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN CUTLER Secretary 404-482-2550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| 122300000X Dentist | |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2022-05-12 |