| NPI | 1154821460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN KIDDER Dentist/Owner 225-761-8585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5901) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2018-02-14 |