| NPI | 1538499041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ANDREW MARTIN Owner 662-323-3801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MS 352809) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2016-01-07 |