| NPI | 1649716523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD FINCHER Owner 662-453-1708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 227286) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2017-01-16 |