| NPI | 1366794711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA JANETTE HAAKE Billing Coordinator 256-258-3883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5311) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2012-10-10 |