NPI age
19 years
Enumerated 2006-12-27
Across 4309 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 | 9183143 | DORAL |
| 01 | 100976 | AVESIS |
| 05 (GA) | 00969251A |
Solo or small practice. No other active providers share this practice address in NPPES.
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