| NPI | 1669643318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN JASON SAMMONS Dentist/Owner 731-668-7412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2008-03-20 |