| NPI | 1720274798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET J. COOKFAIR Practice Manager 770-487-3807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 10465) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2014-03-25 |