NPI age
19 years
Enumerated 2006-11-21
Across 2660 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 011336 | LICENSE |
| 01 (GA) | 582625375 | TAX ID |
Solo or small practice. No other active providers share this practice address in NPPES.
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