| NPI | 1346681863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN G BURRIS Owner 870-972-8294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223G0001X Dentist General Practice | |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2015-03-04 |