| NPI | 1407423437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNI SNOW Credentialing Specialist 678-986-7116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-06-08 |