NPI age
13 years
Enumerated 2012-08-21
Across 200 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | DN122928 | DENTAL LICENSE |
| 01 (KY) | 10383 | DENTAL LICENSE |
| 01 (KS) | 61690 | DENTAL LICENSE |
| 01 (TX) | 28236 | DENTAL LISCENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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