| NPI | 1609541945 |
|---|---|
| Doing Business As | DOCS DENTAL FT. GORDON |
| Entity Type | Organization |
| Authorized Contact | AMANDA ANNE CLARK Director Of Credentialing 267-927-5000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2021-08-10 |