| NPI | 1467345942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY DAVIS Claims Administrator 229-241-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-06-02 |