| NPI | 1750504445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR D. VAN GREUNINGEN CEO 770-454-0510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 12527) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |