| NPI | 1477200137 |
|---|---|
| Doing Business As | KENNESAW MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MICHELLE HOUSTON Owner 678-832-0527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2022-04-26 |