| NPI | 1124516760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOIRA EASLEY Office Manager 225-938-6432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2018-04-30 |