| NPI | 1306279039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANTHONY IENNUSA President/Orthodontist 985-626-4779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: LA 5188) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2013-08-16 |