| NPI | 1518480763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH BRADFORD GILBERT Manager/Owner 770-287-4051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA GA12772) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA GA14767) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2017-07-24 |