| NPI | 1780128660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LAM GEISE President 334-220-9646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 6107) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5853) |
| 1223G0001X Dentist General Practice (Licence: AL 4002) | |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-14 |