| NPI | 1851765556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACE LANIER LYNN Dentist 337-625-9911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA LA5970) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |