NPI | 1740457878 |
---|---|
Entity Type | Organization |
Authorized Contact | JACK P DEVEREUX Owner 985-893-6446 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 3676) |
Enumeration Date | 2008-05-08 |
Last Update Date | 2013-02-28 |