| NPI | 1356862445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CHELETTE Insurance Coordinator 985-893-1044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3502-09) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2017-06-29 |