| NPI | 1477049542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA M WEST Insurance Manager 423-870-9567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 7108) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-07-02 |