| NPI | 1417108366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS COURTNEY MAXWELL Owner 229-671-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 11562) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 11534) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |