| NPI | 1346346848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE MARTIN THOMAS President 731-424-7690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS 1642) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN 146) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |