| NPI | 1558093146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAN HENLEY Operation Manager 346-316-1920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2022-06-30 |