| NPI | 1538823562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BRAGG Owner 678-296-6067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2022-12-06 |