| NPI | 1972010502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA MONELL Business Manager 770-781-8650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 011424) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 015146) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2018-01-04 |