| NPI | 1275840415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONN M FARNI Owner 251-675-4313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AL 4781) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AL 4782) |
| 261QD0000X Clinic/Center, Dental (Licence: AL 4784) | |
| 261QD0000X Clinic/Center, Dental (Licence: AL 5712) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2010-09-09 |