| NPI | 1689219933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA GRISHAM Office Staff 844-726-1800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2019-11-11 |