NPI age
11 years
Enumerated 2014-07-01
Across 2660 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003148592A | |
| 01 (GA) | DN014806 | DENTAL LICENSE |
Part of a multi-provider practice. 27 other active providers share this practice address in NPPES.
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