| NPI | 1881981181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SLADE WALLACE LAIL Dentist/Owner 770-476-5227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA 11701) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-07-07 |