| NPI | 1255850400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HACKER Practice Manager 615-969-4934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2017-09-19 |