| NPI | 1932321007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEA M FARESE Dentist 662-234-8463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3293-04) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3231-02) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |