| NPI | 1114262649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN RAY FONTENOT Owner/Dentist 337-824-4963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: LA 3543) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2012-12-10 |