| NPI | 1184140121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASSEN ALLEN ANTHONY Member 256-431-3184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2022-07-21 |