| NPI | 1225325731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNAKATE MILBURN TATUM Sole Member 870-204-6555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 125) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2011-07-05 |