| NPI | 1689162620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANNA BOYD Practice Manager 770-842-9325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-04-25 |