| NPI | 1326628710 |
|---|---|
| Former Legal Business Name | AZALEA DENTAL |
| Entity Type | Organization |
| Authorized Contact | LESLIE HARGROVE Manager 225-270-3392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2021-04-10 |