NPI | 1588992663 |
---|---|
Entity Type | Organization |
Authorized Contact | CLARICE R WHITE Owner/President 731-548-2400 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TN 5088) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 8059) |
126800000X Dental Assistant (Licence: TN 11357) | |
126800000X Dental Assistant (Licence: TN 13532) | |
Enumeration Date | 2009-11-30 |
Last Update Date | 2009-11-30 |