| NPI | 1265087969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA MICHELLE GARRETT Pediatric Dentist 423-802-6234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2019-08-08 |