| NPI | 1477067783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES THEODORE MELTON Owner 251-990-7797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AL 3784) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2017-11-22 |