| NPI | 1922011600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH PAUL GARDNER Dentist 678-458-9906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |