NPI age
19 years
Enumerated 2006-10-12
Across 358 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00221691A3 | |
| 01 (GA) | 11482856 | CAQH |
| 01 (GA) | 279254 | BLUE SHIELD |
| 01 (GA) | 421490 | UNITED CONCORDIA |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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