| NPI | 1255564340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY D POLAND Business Administrator 931-762-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2017-03-23 |