| NPI | 1316217649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORMAN B BLAUM Member 251-232-1083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 4072) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-08-14 |