| NPI | 1811290497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD S JOHNSON Owner 423-587-8383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS8950) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |