| NPI | 1063387652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ACOSTA Owner 901-363-8192 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |