| NPI | 1942437173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA BROOME Office Manager 985-641-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2013-02-28 |