| NPI | 1578103867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC RICHARD COONEY Operations Director 470-408-5161 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2020-02-05 |