| NPI | 1861514507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED FRANCIS WORRALL Owner 770-792-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 011402) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |