| NPI | 1639362445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MILES MAZZAWI President 770-235-2288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA dn012359) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |