NPI | 1285375873 |
---|---|
Entity Type | Organization |
Authorized Contact | SHERRIE EDMONDSON Manager, Licensing & Certification 629-999-5014 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 122300000X Dentist |
Enumeration Date | 2022-04-06 |
Last Update Date | 2022-08-03 |