| NPI | 1770132581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITANY FABIAN MATIN President, CEO 334-444-0571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2019-09-05 |