| NPI | 1780954461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE M PENNINGTON President 912-673-6545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN011196) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |