| NPI | 1912518531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA MAGUIRE Credentialing Coordinator 678-714-7575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |