NPI age
17 years
Enumerated 2008-05-28
Across 221 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | DN014625 | GEORGIA BOARD OF DENTISTRY |
| 01 (PA) | DS036552 | DENTAL LICENSE NUMBER |
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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