| NPI | 1891002531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RESA JOHNELLE ROBERTS Organizer 404-556-1393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN010168) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2011-09-21 |