| NPI | 1417115882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUVENIA ANNETTE RAINGE CEO 706-790-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 10923) |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2012-08-13 |