| NPI | 1689764896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN A. CLOW Office Manager 770-938-0232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 292200000X Dental Laboratory | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |