| NPI | 1053813527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BRAKE Business Office Manager 423-246-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2018-03-01 |