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 |