| NPI | 1811040728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M JUDGE Doctor Owner 770-541-0101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011180) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 4430) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-06-16 |