| NPI | 1144574922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT EDGEWORTH BOYETT Owner 205-921-0893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 4622) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-01 |