| NPI | 1326602400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON TODD BOLDING Owner 501-230-0938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2019-04-24 |