NPI | 1053799080 |
---|---|
Entity Type | Organization |
Authorized Contact | JENELL STUMP Manager, Licensing & Credentialing 629-999-5006 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2015-05-11 |
Last Update Date | 2018-05-07 |