| NPI | 1619338761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHENIKA KELLY Dentist/Owner 769-572-4425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 364412) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2016-03-17 |