| NPI | 1932531373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES MICHAEL ROBERTSON President 662-842-2448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MS 2571-90) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2013-08-08 |