| NPI | 1619255718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL WALTER BANKSTON Owner Dentist 615-452-6191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN ds3246) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2011-07-25 |