| NPI | 1396472452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KINARD Owner 501-500-8155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2022-08-17 |