| NPI | 1568828143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOULTON D ABERNATHY Owner 731-847-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN DS3005) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2016-01-12 |