| NPI | 1487764049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J. STORIE Chief Manager 423-282-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 6930) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |