| NPI | 1447730692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON JONES Front Office 463-701-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12011675A) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |