| NPI | 1548506975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD WAYNE HOUSEHOLDER Owner 276-979-5796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401005792) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2022-07-21 |