| NPI | 1164986220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL PHAM Manager 334-657-7668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |