| NPI | 1194552521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE GOODLOE Manager 879-329-1098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |