| NPI | 1639182306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH PAUL GARDNER General Dentist 770-564-9906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN01162) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN14123) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |