| NPI | 1508954116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYM MADDOX Corporate Secretary 770-532-8104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN011067) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN011899) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-08-22 |