NPI age
19 years
Enumerated 2007-01-03
Across 539 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 39416 | AVESIS VENDOR # |
| 01 (GA) | 168140 | DORAL PAYEE # |
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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