| NPI | 1689938862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFFER CONNOR Administrative Assistant 678-990-6331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN009113) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: dn009113) |
| 1223G0001X Dentist, General Practice (Licence: GA DN013919) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN013997) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN011863) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |