| NPI | 1679814701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALEY WOOSTER Enrollment Specialist 984-251-8846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3315) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2025-03-10 |