| NPI | 1275707853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LESIA MOORE Dentist 615-720-3765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TN 8455) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |