| NPI | 1588784797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN GRANT RABEDEAUX Owner 641-792-2780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 6944) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |