| NPI | 1982979753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD D WALLS Owner 770-973-1738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN010062) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |