| NPI | 1124156476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD PERRIN ROTEN President 662-837-4664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS MS1279-67) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2008-08-26 |