| NPI | 1083966386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH W CHANCEY Owner/Dentist 334-347-0036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL 3091) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2012-10-10 |