| NPI | 1982817979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA DAWN DERRICK Owner 404-261-6794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA 12259) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |