NPI age
19 years
Enumerated 2006-06-15
Across 4309 active dentist providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (MS) | 00660404 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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