| NPI | 1265301238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER KELLER Managing Member 423-246-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-10-30 |
| Last Update Date | 2025-10-30 |