| NPI | 1609934488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB F HENDERSON Owner 225-261-6645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5406) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-07-14 |