| NPI | 1912870668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE E GIBSON Controlling Partner 423-581-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-09-29 |
| Last Update Date | 2025-09-29 |