| NPI | 1962614610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE A BORETSKY Periodontist 706-653-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: GA DN012109) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2013-01-24 |