| NPI | 1952914715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD ANDERSEN Sole Member 770-542-8999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-08-30 |
| Last Update Date | 2022-07-05 |