| NPI | 1932389467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE PORTER Accounts Receivable Coordinator 662-741-2151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2025-07-08 |