| NPI | 1053449637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY T. RUSSELL Insurance COO Rdinator 901-452-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS3393) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |