| NPI | 1912456930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DOUGLAS OLIVER Owner 870-897-3192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 5151) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2016-10-03 |