| NPI | 1609342864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN J. WINGFIELD Owner 678-906-1769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2018-10-15 |