| NPI | 1972654044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA Y ALMOND Executive Assistant 404-349-7777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 011641) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 011644) |
| 1223G0001X Dentist, General Practice (Licence: GA 011029) | |
| 1223G0001X Dentist, General Practice (Licence: GA 12477) | |
| 1223G0001X Dentist, General Practice (Licence: GA 013181) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 9450) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 10731) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 12174) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |