| NPI | 1396964003 |
|---|---|
| Doing Business As | NORTHSIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK J MOKAS Owner Dentist 770-671-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 011459) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |