| NPI | 1164807145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY SCOTT WILLIAMS Owner 712-303-1219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IA DDS-09199) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |