| NPI | 1770613119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PORTIA MAXINE GRAYSON Owner Dentist 404-917-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012800) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |