| NPI | 1962660795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN CHRISTOPHER ALEX Dentist 706-549-5678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA 010531) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |