NPI | 1407698541 |
---|---|
Entity Type | Organization |
Authorized Contact | DEREK WEIGAND Owner 877-712-7875 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
Enumeration Date | 2024-06-10 |
Last Update Date | 2024-06-10 |