| NPI | 1811168479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVENA FAYE PEAVYHOUSE Office Manager/Hygienist 931-454-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2008-03-21 |