| NPI | 1700975554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SHANE STEVENSON President 256-355-1242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5063) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-10-30 |