| NPI | 1093195117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA BERNICE PHILLIPS Dentist 934-236-4360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OH 30019980) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2015-06-03 |