| NPI | 1992056550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELL DARREN GALLAHER Owner 770-287-0310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 11839) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 013665) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2012-09-24 |