| NPI | 1356657852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER PRENTICE President 423-855-4201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 9065) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2010-08-23 |