| NPI | 1770981763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENE IVERSON Insurance Administrator 404-220-7505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN010345) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2014-12-08 |