| NPI | 1770657124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD JAMES GREEN S Corp President 229-883-3071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN09807) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-08-22 |