| NPI | 1548773773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA MOSS Office Manager 678-674-7176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DNO13554) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DNO15261) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |