| NPI | 1336596196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW CLARK Dentist/Owner 731-431-5613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9483) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-05-20 |