| NPI | 1811135296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI FOUNTAIN GARDNER Dental Hygienist 706-647-7914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 11133) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |