| NPI | 1861403552 |
|---|---|
| Other Name | SECOND FACILITY OPENED |
| Entity Type | Organization |
| Authorized Contact | PHILIP K TALLEY Dentist Owner 770-368-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |