| NPI | 1538298435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RICHARD FANA President 912-352-3955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011627) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2016-05-09 |