| NPI | 1417027939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT E STANSELL President 770-867-2277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 10705) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 9836) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-08-22 |