| NPI | 1972779528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ERIC OLSON President/Owner 770-424-8077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA dn010233) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2008-05-05 |