| NPI | 1821259854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LONG Office Manager 770-978-3292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 011818) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2008-06-23 |