| NPI | 1366725582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANNE O. CORE Owner 985-630-6906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 2392) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3600) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2016-06-23 |