| NPI | 1588947212 |
|---|---|
| Doing Business As | BUENA VISTA DENTAL |
| Entity Type | Organization |
| Authorized Contact | DALE MAYFIELD President 770-916-5028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2014-12-19 |