| NPI | 1699780163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT E ELLIS Managing Partner 770-962-9515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN009242) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |