| NPI | 1376983213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THANE HISAW President 907-315-6812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 9508) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2013-06-27 |