| NPI | 1871687624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYAL DONERLSON MCCULLOUGH Owner 770-961-1222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 10775) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |