| NPI | 1639607104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHIDA OCHILL Office Manager 318-631-3464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5534) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6613) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2022-07-21 |