| NPI | 1114186699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRIE EDMONDSON Sr Manager, L& C 629-999-5014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-03-04 |