| NPI | 1518302165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF RODGERS Owner 770-394-4310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 011381) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |