| NPI | 1558796896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY EARL MUCCIOLI Owner/Dentist 678-389-9955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014378) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DN014379) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2013-09-05 |