| NPI | 1750887576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MORRIS Owner 772-418-2612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VT VT016.0107639) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2018-04-02 |