| NPI | 1861265647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE E VIAL Direc Of Cred And Prov Rel 615-638-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2023-11-02 |