| NPI | 1386848638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI LYNN REZABEK Credential Specialist 901-685-8090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-08-22 |