| NPI | 1417174723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE D ALLEN Manager 478-272-1933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 012354) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 11329) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2024-08-01 |