| NPI | 1790276277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH KING Owner 844-882-3127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 152W00000X Optometrist |
| 231H00000X Audiologist | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2018-05-21 |