| NPI | 1841524295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGAN V GORDON Business Manager 770-479-5425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA GA012160) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2009-10-01 |