| NPI | 1427163666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EDWARD WITKOWSKI Owner 423-283-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS004426) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-08-22 |