| NPI | 1386363422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET BURRIS Owner 870-926-5322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |