NPI | 1568808673 |
---|---|
Entity Type | Organization |
Authorized Contact | SHERRIE EDMONDSON Manager, Licensing & Credentialing 629-999-5014 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
Enumeration Date | 2013-05-15 |
Last Update Date | 2021-12-30 |