| NPI | 1407979099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE THEODORE TADSEN President, Owner 770-995-6215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN008626) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |