NPI | 1558528935 |
---|---|
Entity Type | Organization |
Authorized Contact | ROBERT JAMES POLKING Owner 641-424-9398 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA IA 6422) |
Enumeration Date | 2008-05-22 |
Last Update Date | 2012-07-17 |