| NPI | 1124283932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA ANN JOHNSON Office Manager 931-528-5105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-06-14 |