| NPI | 1659401966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAKER K VINCI Owner 225-923-3223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA LA4742) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |