NPI | 1558701177 |
---|---|
Entity Type | Organization |
Authorized Contact | RICHARD WAYNE BLAKE Owner/President 1904-743-2000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 0005634) |
Enumeration Date | 2013-06-27 |
Last Update Date | 2013-06-27 |