| NPI | 1720417280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIPSON MARK KINGRY Orthodontist 334-272-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 4440) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |