| NPI | 1780812610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINAMRA BHASIN Member 478-923-0232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 7417) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN 013545) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2009-06-30 |