| NPI | 1801238654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMIE BRYANT HAMMACK Owner 225-664-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 2288) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6357) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |