| NPI | 1700484094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY B. MOODY Owner 404-642-6630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |