| NPI | 1376623074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT M HILDENBRAND President 662-840-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 267792) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 324002) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-06-02 |