| NPI | 1073944997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL S MANSOURI Dentist/Owner 267-441-2565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: GA DN012848) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2013-12-03 |