| NPI | 1568873032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL ANDREW TROUT Pediatric Dentist 1701-232-1148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ND 2168) |
| Enumeration Date | 2014-05-18 |
| Last Update Date | 2014-05-18 |