| NPI | 1184721367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RUSSELL President 662-328-1521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS OR15888) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-04-10 |