| NPI | 1962236380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY GOLDMAN Owner 706-546-7362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-10-31 |