| NPI | 1841343316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROBERT DAVENPORT Doctor 770-487-7734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA 009974) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2012-10-02 |