| NPI | 1063585404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVIN S POLK Secretary Treasurer 615-333-2833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS3842) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN DS3729) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-08-22 |