| NPI | 1538392493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH MORRIS WIGGINS President 770-226-0008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA dn012484) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: GA dn012485) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2009-08-26 |