| NPI | 1104432939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAIR A. ISOM Owner 702-756-8422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |