| NPI | 1295594307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK WEIGAND Owner 877-712-7875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-19 |