| NPI | 1376955351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES O COULTER Owner 404-389-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013607) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |