| NPI | 1598497653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA HARP Cbo Leader 678-372-7358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |