| NPI | 1568561231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD FULTON GODAT President 423-239-3993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TN DS2061) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-08-22 |