| NPI | 1538879648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATHONIA BENNETT Dentist 912-996-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2025-05-18 |