| NPI | 1497857411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH PAUL GARDNER Dentist 770-564-9906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN01162) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN14123) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-08-22 |