| NPI | 1821109919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA MIZE RIX President 706-235-4723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: GA 011053) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |