| NPI | 1366581886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CLARK BENTON President 225-664-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 3057) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2014-02-25 |