| NPI | 1013179746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JOSEPH WIGHTMAN Dentist/Owner 504-272-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5747) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5746) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2008-06-25 |