| NPI | 1700239092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURT ROTHERMEL Dentist 337-783-2113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 4310) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6570) |
| 124Q00000X Dental Hygienist (Licence: LA 4418) | |
| 124Q00000X Dental Hygienist (Licence: LA 3938) | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |