| 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 |