| NPI | 1073016937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN KENNEDY Owner 864-501-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4377) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4377) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-16 |