| NPI | 1740469311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACY N JOHNSON Office Manager 205-991-9787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AL 3923) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AL 3935) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-31 |