| NPI | 1407602188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IMELDA CREWS Owner 770-886-8911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-04-24 |
| Last Update Date | 2024-04-24 |