NPI age
19 years
Enumerated 2006-06-12
Across 4309 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (SC) | ZG8755 | |
| 05 (GA) | 00139598B | |
| 05 (GA) | 00139598D |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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