| NPI | 1245403708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE DECOLIBUS Owner 901-680-0377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 7389) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2008-04-04 |