| NPI | 1134312226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JOSEPH KRUSA Dentist 931-484-3664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN DS2393) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |