| NPI | 1508085671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY J MAZER Owner 678-624-0370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 012287) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 012301) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |