| NPI | 1184915274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONTIZE G. BROWN Office Manager 337-788-0677 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 4940) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5509) |
| 122300000X Dentist (Licence: LA 5665) | |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2011-04-25 |