| NPI | 1760117154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCENDA HARRIS Credentialing And Contracting COO Rd 980-729-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-07-19 |