| NPI | 1801000609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD GILILLAND Owner 662-234-4822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2009-08-27 |