| NPI | 1669590121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WILLIAM MOORMAN President Of Corporation 770-483-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |