| NPI | 1942039201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE LEWIS TOLLISON Owner 864-918-9880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-08-20 |