| NPI | 1770608176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE WESLEY HUTHWAITE Doctor 770-536-8868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 11253) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |