| NPI | 1558436485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JEFFERSON GRAVES President 205-923-6828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 3419) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AL 2563) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 3460) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2020-08-22 |