| NPI | 1376181347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMONIA LEONARD Credentailing Specialist 678-244-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2019-12-20 |