| 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 |