| NPI | 1487879821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN C BALLAR Office Manager 770-497-1045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 8321) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-08-22 |