| NPI | 1558579607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES IRVINE LOPEZ President 706-324-1834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 9074) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 9074) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |