| NPI | 1891896148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL A CLARK VP 985-624-5449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA LA4476) |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-09-11 |