| NPI | 1710203807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENNEA ALFONSO Office Manager 225-761-8585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 3017) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5901) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2010-04-14 |