| NPI | 1538571435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS J SIDOW Owner Surgeon 706-860-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN013478) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |