| NPI | 1801160031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE GUFFIN Adminsitrator 770-499-2152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN013572) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2012-03-06 |