| NPI | 1700437969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANINE HANSON Practice Manager 205-979-9480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2019-09-27 |