| NPI | 1811222623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE MARIE DAVIS Owner/Position 770-831-7644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN011750) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: GA DN011750) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2009-10-13 |