| NPI | 1912092651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAUREEN SHERIDAN FENTON Owner 318-868-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4009) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2017-02-08 |