| NPI | 1154877686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER BRADLEY DICKERSON Owner 985-641-2030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 2368) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2016-08-25 |