| NPI | 1396049698 |
|---|---|
| Former Legal Business Name | LIVE OAK DENTAL |
| Entity Type | Organization |
| Authorized Contact | SUMAN R NALLA Director 603-233-1889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25949) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2010-12-29 |