| NPI | 1649550716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA AMANDA President 1855-377-7433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-08-22 |