| NPI | 1568133627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN GRODIN CEO 770-851-8383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |