| NPI | 1548909294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA LAYEL Assistant Vice President Finance 423-869-6229 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0300X Dentist Periodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0008X Dentist Oral and Maxillofacial Radiology | |
| 124Q00000X Dental Hygienist | |
| 261QD0000X Clinic/Center Dental | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2023-05-03 |