| NPI | 1679059539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD WOOLBERT Manager 318-868-8276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: LA 4020) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2018-07-13 |