| NPI | 1932329844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA THOMAS MOSES Periodontis 770-832-0089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA 11025) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |