| NPI | 1689238446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD ANDERSEN Owner 770-542-8999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2020-12-08 |