| NPI | 1912303561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RON D WILSON Owner 770-536-0882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 12912) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |