| NPI | 1447623830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA RODRIGGS Gmp 385-355-1434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9030705) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 135181) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2015-11-06 |