| NPI | 1508918343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAYTON CHARBONNET Doctor 9853-403-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 2349) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |