| NPI | 1982072633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN SMITH CFO 770-231-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2025-01-21 |