| NPI | 1376027862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATHIA MATTILA Office Manager 423-855-4201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2018-09-20 |