| NPI | 1871943662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON VANCIL Office Manager 678-714-6343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 012441) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: GA 012441) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2018-05-02 |