| NPI | 1497216980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY M LAWHORN President 912-764-4495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |