| NPI | 1457806317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY EMMETT MOORE Owner/Doctor 225-405-5066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5491) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2017-01-18 |