| NPI | 1659893550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA PAYNE Owner 985-626-0160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 6567) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2018-03-17 |