| NPI | 1528331923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN A OWENS Owner 770-469-1331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 12130GA) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN09316) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2012-08-01 |