| NPI | 1548463466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK DANIEL MALLETTE Owner Provider 901-484-3812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS8406) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-08-22 |