NPI age
19 years
Enumerated 2007-01-03
Across 4309 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 582307246 | TAX ID |
| 05 (GA) | 000678829B | |
| 01 (GA) | 9181858 | DORAL |
| 01 (GA) | 100819 | AVESIS |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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