| NPI | 1356983746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER MYERS Owner 912-432-0685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |