| NPI | 1487837423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE ELLIS Owner 770-972-7911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 07968) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN012320) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2013-02-21 |