| NPI | 1548971799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY SUE RHEA-BOHNENKAMP President & Authorized Official 712-899-9704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2026-05-09 |