| NPI | 1790970614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAYO OBEBE Director 706-243-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA 011235) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 011235) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-09-13 |