| NPI | 1578200010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JACOMINO Director Of Payor Relations 770-916-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-05-17 |