| NPI | 1639553746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN WINGFIELD Sole Mbr 678-906-1769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30690) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |