| NPI | 1710902358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA C CALLICUTT Owner 770-753-0067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 011273) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |