| NPI | 1689814790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FRANKLIN DAVENPORT Owner 985-892-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: LA 5713) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2009-03-02 |