| NPI | 1760668404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VARNELL GAINES Dentist 706-738-0482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN008943) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2008-01-11 |