| NPI | 1700395365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMONIA LEONARD Credentialing Specialist 678-244-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2019-07-09 |