| NPI | 1922562438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE T ROGERS Office Manager 985-853-1142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2020-01-14 |