| NPI | 1003113879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN BRYANT HIRSBERG Orthodontist 662-627-9001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3042-98) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2011-02-14 |