| NPI | 1750190898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW RICHARDSON Owner 334-354-4027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-01-03 |