| NPI | 1700420445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMONIA LEONARD Credentialing Specialist 678-244-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2019-11-06 |