| NPI | 1922553676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SNOW Credentialing Coordinator 404-410-1340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-08-23 |