NPI age
19 years
Enumerated 2007-04-25
Across 539 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00412079A | |
| 01 (GA) | 827601 | UNITED CONCORDIA NUMBER |
| 01 (GA) | DN010597 | GEORGIA LICENSE NUMBER |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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