NPI | 1104150069 |
---|---|
Entity Type | Organization |
Authorized Contact | HALEY WOOSTER Enrollment Specialist 712-733-8551 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 122300000X Dentist (Licence: TX 0021124) |
Enumeration Date | 2009-09-25 |
Last Update Date | 2021-11-17 |