| NPI | 1497512263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSY KOSHY Dentist 770-993-7947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-02-28 |