| NPI | 1548558943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY P. TIDWELL Business Manager 931-762-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS9109) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2011-07-19 |