| NPI | 1992050686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN PATRICIA WISE Owner 770-387-4354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DNO010942) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2017-06-23 |