| NPI | 1629554639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY PLAYFORTH Office Manager 270-469-1156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2018-07-12 |