| NPI | 1710434204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE SUZANNE WALLACE Dentist 615-545-1812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 8973) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |