| NPI | 1932171667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORSHALLE NICHOLE SMITH Revenue Cycle Manager 346-772-3944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2024-06-12 |