| NPI | 1639813454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL COLEMAN RILEY Authorized Official 769-567-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2023-12-28 |