| NPI | 1760558167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER T DICKSON Dentist 205-248-9077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 4990) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 4999) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-08-22 |