| NPI | 1396069613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANGELA K CRISWELL Business Office Director 8473-663-1013 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4406) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2010-03-16 |