| NPI | 1104812213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN R PITTMAN President 423-929-8011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN D52049) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-08-22 |