| NPI | 1134345184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANDREW VENTRESS Owner 225-926-8954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5147) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |