| NPI | 1083662290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE GARGIS MCILWAIN Office Manager 256-383-1499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-08-22 |