| NPI | 1699202960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW TICOLA Manager 256-505-8954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AL D0005747-C) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2017-05-17 |