| NPI | 1790162998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO ANN RICE Credentialing Manager 470-881-8679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 14922) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-12-03 |