| NPI | 1750431961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA C DAVIS Owner 770-471-5255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA dno11238) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |