| NPI | 1700208642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA HAWKINS HISSAM Dentist 912-777-5767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013433) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-01-17 |