| NPI | 1861535759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY WINN Owner 423-472-6482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 7761) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 8088) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2024-09-18 |