| NPI | 1871954479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER BOULDEN Owner 706-781-3340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012542) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-03-10 |