| NPI | 1598265944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMONIA LEONARD Credentialing Specialist 678-244-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2018-07-18 |