| NPI | 1528582947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE ANN GRAY Owner 662-328-3833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: MS 3039-98) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3039-98) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2022-07-21 |