| NPI | 1376024810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRAKE JOLIVETTE Business Manager 225-402-4004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6602) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2018-09-13 |