| NPI | 1851366462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA S ZOELLER VP, Legal Licensing & Credentialing 478-781-4333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2016-09-06 |