| NPI | 1205197647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW NICHOLS President 931-954-5244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS0000009136) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2012-06-01 |