| NPI | 1912173022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE MARTIN Administrative Assistant 229-247-5590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN008219) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-05-08 |