| NPI | 1588759732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN F CARRELL President 712-246-4391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA 7243) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 7818) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |