| NPI | 1699041996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE J KRAWCHUK Practice Administrator 912-354-7693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN 011248) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2012-03-30 |