| NPI | 1790274603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY GOGGANS Owner 800-864-1582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3983-18) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-05-04 |