| NPI | 1760996656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA MONELL Business Administrator 770-781-8650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN011242) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN014775) |
| 1223G0001X Dentist General Practice (Licence: GA DN015174) | |
| 1223G0001X Dentist General Practice (Licence: GA DN015214) | |
| 1223G0001X Dentist General Practice (Licence: GA DN012306) | |
| 1223G0001X Dentist General Practice (Licence: GA DN015212) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN015146) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: GA DN011424) | |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2018-01-05 |