| NPI | 1396124152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER THAMES Dmd, Owner 901-850-7338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 9203) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |