| NPI | 1073896585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL MARIE DONALDSON President 985-641-7971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 5178) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |