| NPI | 1659199727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE D CARIDE Credentialing 470-207-3264 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist General Practice | |
| Enumeration Date | 2024-09-28 |
| Last Update Date | 2024-09-28 |