| NPI | 1861572018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEACH President 770-521-8855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN012732) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN011522) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |