| NPI | 1821768789 |
|---|---|
| Former Legal Business Name | WINN SMILES SHALLOWFORD |
| Entity Type | Organization |
| Authorized Contact | ANN MARIE MULLER Administrative 423-310-7424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2021-09-16 |