NPI | 1033751698 |
---|---|
Entity Type | Organization |
Authorized Contact | CATHERINE M JENSEN Provider Relations Speicalist 800-544-2345 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2019-10-15 |
Last Update Date | 2019-10-15 |