| NPI | 1861664880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY MIXSON Owner 770-333-9951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012436) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |