| NPI | 1386740140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP BRENT ELLEDGE Owner 256-534-5028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AL 5313) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-08-15 |