| NPI | 1720181852 |
|---|---|
| Former Legal Business Name | EASTDALE DENTAL GROUP PC |
| Entity Type | Organization |
| Authorized Contact | KILLIAN JOSEPH HORNER Owner/President 334-271-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-08-22 |