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 |