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 |