| NPI | 1750470324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL T. MCDONALD President 662-256-5601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 1549-73) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |