| NPI | 1558094698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERYN ENCE Owner 725-344-1888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2024-02-08 |