| NPI | 1538835871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON CHAMPAGNE Owner 775-636-9939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-10-15 |