| NPI | 1891966826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DINA YELIZAROV Bussiness Manager 770-772-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011361) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |