| NPI | 1831887553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH JOHNSON FANCHER Dentist/Owner 865-229-4969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-01 |