| 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 |