| NPI | 1760685788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ELIAS ABIDE President 662-378-8606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 195782) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-08-22 |