| NPI | 1760186811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENTHES FIELDS Credentialing Specialist 678-599-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |