| NPI | 1104584515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JANE WARD Senior VP Finance 318-716-4937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2021-12-02 |