| NPI | 1902264252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAVEL TSUR-TSAR Owner 770-266-7188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2016-02-02 |