| NPI | 1215135280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURENCE MATTHEW HAGE Owner 228-864-3416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3271-03) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2007-07-10 |