| NPI | 1316306988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY W PARKER Owner 228-392-0509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3553-10) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2016-02-11 |