| NPI | 1447475959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CLELAND FRASER Periodontist 770-412-6575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: GA DN012684) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2008-07-23 |