NPI age
19 years
Enumerated 2007-03-21
Across 4309 active dentist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (TN) | DS0000004699 | STATE LICENSE NUMBER |
| 01 (GA) | DN010304 | STATE LICENSE NUMBER |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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