| NPI | 1922585694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMONIA LEONARD Credentialing Speciailst 678-244-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2018-07-26 |