NPI | 1093262974 |
---|---|
Entity Type | Organization |
Authorized Contact | LANETTE L HENRY Office Administrator 228-896-5197 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 2005-83) |
Enumeration Date | 2016-09-08 |
Last Update Date | 2016-09-08 |