| NPI | 1912633900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITANY FABIAN MATIN Periodontist/Owner 334-209-1352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2022-08-02 |