| NPI | 1114214426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN O BLANTON Owner 901-853-8116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 4231) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-10-31 |