| NPI | 1104205905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN RYAN ROGENMOSER Owner/Member 318-445-0667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: LA 6442) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2015-05-26 |