| NPI | 1750633319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA W WEBB Office Manager 706-882-0591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 009828) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 014409) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-10-08 |