NPI | 1568842987 |
---|---|
Entity Type | Organization |
Authorized Contact | KATINA RENE BEVERLY Pediatric Dentist 1202-215-4731 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 5856) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 5857) |
Enumeration Date | 2015-06-01 |
Last Update Date | 2015-06-02 |