| NPI | 1972042380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA TARD Business Manager 770-333-9951 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA DN013527) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |