| NPI | 1417168493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI H SELPH Receptionist 478-272-3727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN012942) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 10879) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |