| NPI | 1609632082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN SMITH Chief Officer 770-231-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-02-23 |