| NPI | 1336632561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN D LACKEY Front Office 256-595-2131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-07-05 |