| NPI | 1295567006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY A RICCARDI Sole Proprietor 229-924-2224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |