| NPI | 1932255924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER MASON AO 256-428-7560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL AL5452) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AL AL2505) | |
| 1223P0300X Dentist, Periodontics (Licence: AL AL3965) | |
| 207Q00000X Family Medicine | |
| 207Y00000X Otolaryngology | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2026-07-13 |