| NPI | 1487842951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CLELAND FRASER Dentist 770-483-4469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: GA DN012684) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN012684) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2016-05-02 |