| NPI | 1376115758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN SMITH CEO 770-231-5348 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |