| NPI | 1619424827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA KIM Dentist 678-924-9848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA DN015143) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: PA DS040187) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2016-09-06 |