| NPI | 1730967399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE LYNN WATKINS Insurance Admin 740-773-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2023-09-15 |