| NPI | 1447734447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONI HOWELL PORTER Clinic Administrator 318-381-9340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |