| NPI | 1730219130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORI MORDECAI Office Manager 662-329-3931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 1284-07) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |