| NPI | 1205288099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CROSSLEY President 478-923-6449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |