| NPI | 1578091815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL WAYNE BUSH Dentist/Owner 334-504-0142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 6240) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2017-05-31 |