| NPI | 1992103428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM MAZZUCKELLI Manager 678-592-1125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA DN011417) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |