| NPI | 1811169071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C. MICHAEL LOCKE Owner 931-455-2105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS0000007685) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2022-12-02 |