| NPI | 1932833217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BISHARA Owner 678-754-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-07-13 |