| NPI | 1619207719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY M JOHNSON Manager 256-774-7228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AL 5290) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2010-01-12 |