| NPI | 1407346505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRON D. SIMMONS President 706-546-1716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: GA 006804) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |