| NPI | 1972837318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGAN V GORDON Business Manager 770-977-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012338) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2009-10-01 |