| NPI | 1851655187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOMMER NICOLE MAYNOR Credentialing Mgr 423-541-5427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2024-05-06 |