| NPI | 1104314624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM F PROFFITT Owner 844-700-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413088) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2018-04-30 |