| NPI | 1205115193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATELYN MITCHELL Insurance Coordinator 385-224-2794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 4748626) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2026-01-20 |