| NPI | 1104533660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA HAWKINS HARRIS Accounts Receiveable Analyst 544-077-6655 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2022-11-03 |