| NPI | 1639269038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK VAN MILES President 912-355-7790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA 10050) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA 10049) |
| 1223E0200X Dentist, Endodontics (Licence: GA DN013720) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2013-05-14 |