| NPI | 1164694824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAN D DUCKETT President 7032-410-5775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008677) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2008-04-02 |