| NPI | 1477574994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANTE TOMASELLI Partner 770-422-5220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: GA 8545) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: GA 10829) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-08-22 |