| NPI | 1881073716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL ROBERT HALL Pres 662-728-2123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3645 12) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2015-05-26 |