| NPI | 1073294989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HILLARY BERRY Owner 877-712-7875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2024-07-08 |