NPI | 1194961607 |
---|---|
Entity Type | Organization |
Authorized Contact | THOMAS HATHORN Partner 318-448-3804 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: LA 3154) |
Additional Taxonomies | 122300000X Dentist (Licence: LA 5576) |
122300000X Dentist (Licence: LA 2775) | |
Enumeration Date | 2009-01-05 |
Last Update Date | 2009-01-05 |