| NPI | 1275067282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY EMMETT MOORE Doctor/Owner 225-677-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5491) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |