| NPI | 1093816837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE VIDRINE BACKUS Orthodontist 205-879-0557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AL 5065) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |