| NPI | 1932840048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER E PRENTICE Owner 423-855-4201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |