| NPI | 1376929125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN A WALLS Owner/CEO 404-444-8485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 010715) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 9711) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |