| NPI | 1104122779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY WALLACE Office Manager 251-342-2324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 4597) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2011-01-31 |