| NPI | 1376996512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE A SHAMBURGER Mbr 334-356-0228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2024-12-17 |