| NPI | 1578778841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BLAIZE DAYOUB Periodontist 912-355-2688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA 008011) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |