| NPI | 1649558859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JENNINGS EBERTING Owner 865-983-3570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2011-07-22 |