| NPI | 1508929084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES V. KOGLER Practice Administrator 770-949-3797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |