| NPI | 1740851492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN DAVID SHADBURNE Pediatric Dentist 270-218-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2021-07-04 |
| Last Update Date | 2023-10-04 |